Provider Demographics
NPI:1881857845
Name:AFGHANI, PHILIP A (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:AFGHANI
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 1:840 DUNLAWTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4224
Mailing Address - Country:US
Mailing Address - Phone:386-492-4881
Mailing Address - Fax:386-492-4887
Practice Address - Street 1:840 DUNLAWTON AVE STE B
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4224
Practice Address - Country:US
Practice Address - Phone:386-492-4881
Practice Address - Fax:386-492-4887
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002888700Medicaid
FL002888700Medicaid