Provider Demographics
NPI:1609948751
Name:CHAO, PHILIP T (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:T
Last Name:CHAO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 OAKLAND RD STE A104
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2450
Mailing Address - Country:US
Mailing Address - Phone:408-392-9611
Mailing Address - Fax:
Practice Address - Street 1:1630 OAKLAND RD STE A104
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2450
Practice Address - Country:US
Practice Address - Phone:408-392-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor