Provider Demographics
NPI:1689602351
Name:HALLETT, PHILIP D (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:HALLETT
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 1:8058 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7846
Mailing Address - Country:US
Mailing Address - Phone:317-852-5981
Mailing Address - Fax:
Practice Address - Street 1:610 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1716
Practice Address - Country:US
Practice Address - Phone:765-482-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350052484OtherRAILROAD MEDICARE
IN200265730Medicaid
INU52734Medicare UPIN
IN350052484OtherRAILROAD MEDICARE