Provider Demographics
NPI:1104929371
Name:STRAW, PHILIP A (DC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:STRAW
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 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:23101 LAKE CENTER DR
Practice Address - Street 2:100
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2801
Practice Address - Country:US
Practice Address - Phone:949-297-3704
Practice Address - Fax:949-297-3706
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154629699OtherGROUP NPI
CADC24628OtherCHIROPRACTIC LICENSE