Provider Demographics
NPI:1730360959
Name:PHILO CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:PHILO CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-889-0550
Mailing Address - Street 1:76 NORTHEASTERN BLVD
Mailing Address - Street 2:UNIT 32A
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3174
Mailing Address - Country:US
Mailing Address - Phone:603-889-0550
Mailing Address - Fax:603-889-0355
Practice Address - Street 1:76 NORTHEASTERN BLVD
Practice Address - Street 2:UNIT 32A
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3174
Practice Address - Country:US
Practice Address - Phone:603-889-0550
Practice Address - Fax:603-889-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2740687B111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7360Medicare PIN