Provider Demographics
NPI:1861403784
Name:CORDOVA, PHILIP VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:VINCENT
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1770 SAINT JAMES PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3471
Mailing Address - Country:US
Mailing Address - Phone:713-622-3300
Mailing Address - Fax:713-622-3207
Practice Address - Street 1:1770 SAINT JAMES PL
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3471
Practice Address - Country:US
Practice Address - Phone:713-622-3300
Practice Address - Fax:713-622-3207
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor