Provider Demographics
NPI:1700972635
Name:RINALDO, PHILLIP (DC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:RINALDO
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 1:16960 W BELL RD STE 501
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8946
Mailing Address - Country:US
Mailing Address - Phone:623-242-1153
Mailing Address - Fax:
Practice Address - Street 1:16960 W BELL RD STE 501
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8946
Practice Address - Country:US
Practice Address - Phone:623-242-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004532341OtherBLUE CROSS BLUE SHIELD
U83646Medicare UPIN
U83646Medicare UPIN