Provider Demographics
NPI:1770778730
Name:MAURER, PHILIP DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DEAN
Last Name:MAURER
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 1:309 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-3031
Mailing Address - Country:US
Mailing Address - Phone:406-628-9322
Mailing Address - Fax:406-628-9321
Practice Address - Street 1:113 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3137
Practice Address - Country:US
Practice Address - Phone:406-628-9322
Practice Address - Fax:406-628-9321
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTU59190Medicare UPIN