Provider Demographics
NPI:1336247675
Name:PHILIPSON, BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PHILIPSON
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 1:1 WOODBRIDGE CTR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1150
Mailing Address - Country:US
Mailing Address - Phone:732-636-6622
Mailing Address - Fax:732-636-3669
Practice Address - Street 1:1 WOODBRIDGE CTR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1150
Practice Address - Country:US
Practice Address - Phone:732-636-6622
Practice Address - Fax:732-636-3669
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00492700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPH500098CYTMedicare ID - Type Unspecified
NJ672326Medicare ID - Type UnspecifiedGROUP NUMBER
NJU64110Medicare UPIN