Provider Demographics
NPI:1912978156
Name:WESTERBECK, PHILLIP ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANDREW
Last Name:WESTERBECK
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 1:1929 DAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650
Mailing Address - Country:US
Mailing Address - Phone:724-532-3077
Mailing Address - Fax:724-532-3155
Practice Address - Street 1:1929 DAILEY AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650
Practice Address - Country:US
Practice Address - Phone:724-532-3077
Practice Address - Fax:724-532-3155
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005833L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
615579OtherBLUE SHIELD
1613441OtherBCBS - GROUP #
615579OtherBLUE SHIELD