Provider Demographics
NPI:1982890869
Name:CHADWELL, PHILLIP LANGE (DC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LANGE
Last Name:CHADWELL
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 1:5103 EASTMAN AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6724
Mailing Address - Country:US
Mailing Address - Phone:989-423-1275
Mailing Address - Fax:989-423-1247
Practice Address - Street 1:5103 EASTMAN AVE
Practice Address - Street 2:STE 140
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6785
Practice Address - Country:US
Practice Address - Phone:989-832-3066
Practice Address - Fax:989-486-3842
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPC007008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E60108OtherBCBSM
MI3083544Medicaid
MI950E60108OtherBCBSM