Provider Demographics
NPI:1740295609
Name:BLAND, PHILIP EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EDWARD
Last Name:BLAND
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 1:903A N BLOOMINGTON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9612
Mailing Address - Country:US
Mailing Address - Phone:479-633-8917
Mailing Address - Fax:
Practice Address - Street 1:903A N BLOOMINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9612
Practice Address - Country:US
Practice Address - Phone:479-633-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor