Provider Demographics
NPI:1548485626
Name:KLEIN, PHILLIP (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:KLEIN
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 1:757 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1904
Mailing Address - Country:US
Mailing Address - Phone:845-362-9200
Mailing Address - Fax:845-362-4405
Practice Address - Street 1:757 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1904
Practice Address - Country:US
Practice Address - Phone:845-362-9200
Practice Address - Fax:845-362-4405
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO6276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX48291Medicare ID - Type Unspecified