Provider Demographics
NPI:1306953518
Name:RAVINALE, PHILLIP K (DC)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:K
Last Name:RAVINALE
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 1:10833 DONNER PASS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161
Mailing Address - Country:US
Mailing Address - Phone:530-587-3776
Mailing Address - Fax:530-587-3797
Practice Address - Street 1:10833 DONNER PASS RD STE 201
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161
Practice Address - Country:US
Practice Address - Phone:530-587-3776
Practice Address - Fax:530-587-3797
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22442Medicare ID - Type Unspecified
U56108Medicare UPIN