Provider Demographics
NPI:1932148517
Name:PHILLIPS, DAVID ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:PHILLIPS
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 1:5779 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2360
Mailing Address - Country:US
Mailing Address - Phone:716-681-6750
Mailing Address - Fax:716-681-6753
Practice Address - Street 1:5779 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2360
Practice Address - Country:US
Practice Address - Phone:716-681-6750
Practice Address - Fax:716-681-6753
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008560-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU66626Medicare UPIN
NY14368-BMedicare ID - Type UnspecifiedCHIROPRACTOR