Provider Demographics
NPI:1760507537
Name:COBB, PHILIP ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANDREW
Last Name:COBB
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 1:1526 SE 16TH PL
Mailing Address - Street 2:#B
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3851
Mailing Address - Country:US
Mailing Address - Phone:239-458-8800
Mailing Address - Fax:239-458-5291
Practice Address - Street 1:1526 SE 16TH PL
Practice Address - Street 2:#B
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3851
Practice Address - Country:US
Practice Address - Phone:239-458-8800
Practice Address - Fax:239-458-5291
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70097OtherBLUE CROSS BLUE SHIELD
FL2443219OtherCIGNA
FL2443219OtherCIGNA