Provider Demographics
NPI:1245462175
Name:MARIEL PHILLIP, D.C.,LLC
Entity type:Organization
Organization Name:MARIEL PHILLIP, D.C.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHILLIP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-952-0369
Mailing Address - Street 1:1243 MINERAL SPRING AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4636
Mailing Address - Country:US
Mailing Address - Phone:401-952-0369
Mailing Address - Fax:401-722-7631
Practice Address - Street 1:1243 MINERAL SPRING AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4636
Practice Address - Country:US
Practice Address - Phone:401-952-0369
Practice Address - Fax:401-722-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00577305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service