Provider Demographics
NPI:1013097930
Name:FIERRO, PHILLIP J (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:J
Last Name:FIERRO
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 1:16421 N TATUM BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3457
Mailing Address - Country:US
Mailing Address - Phone:602-485-8000
Mailing Address - Fax:602-485-8010
Practice Address - Street 1:16421 N TATUM BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3457
Practice Address - Country:US
Practice Address - Phone:602-485-8000
Practice Address - Fax:602-485-8010
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72471Medicare UPIN