Provider Demographics
NPI:1891234829
Name:PHILIPS, RAYMOND JOE (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOE
Last Name:PHILIPS
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 1:505 S PACIFIC AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2656
Mailing Address - Country:US
Mailing Address - Phone:310-666-4721
Mailing Address - Fax:310-751-7002
Practice Address - Street 1:505 S PACIFIC AVE
Practice Address - Street 2:STE 104
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2656
Practice Address - Country:US
Practice Address - Phone:310-666-4721
Practice Address - Fax:310-751-7002
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268581111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician