Provider Demographics
NPI:1699889097
Name:POKORNY, PHILLIP JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JAMES
Last Name:POKORNY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:110 S IDAHO RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85219-2379
Mailing Address - Country:US
Mailing Address - Phone:480-671-5655
Mailing Address - Fax:480-617-5705
Practice Address - Street 1:110 S IDAHO RD
Practice Address - Street 2:SUITE 140
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-2379
Practice Address - Country:US
Practice Address - Phone:480-671-5655
Practice Address - Fax:480-617-5705
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79511Medicare PIN