Provider Demographics
NPI:1467632877
Name:RAKE, PHILIP DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DAVID
Last Name:RAKE
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 1:2048 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1605
Mailing Address - Country:US
Mailing Address - Phone:818-249-8326
Mailing Address - Fax:818-352-1105
Practice Address - Street 1:2048 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1605
Practice Address - Country:US
Practice Address - Phone:818-249-8326
Practice Address - Fax:818-352-1105
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15357111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15357Medicare PIN
CAT18048Medicare UPIN