Provider Demographics
NPI:1720075997
Name:MAHAN, PHILIP ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW
Last Name:MAHAN
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 1:813 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3150
Mailing Address - Country:US
Mailing Address - Phone:336-243-8000
Mailing Address - Fax:336-243-8001
Practice Address - Street 1:813 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3150
Practice Address - Country:US
Practice Address - Phone:336-243-8000
Practice Address - Fax:336-243-8001
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2024315OtherFITSR HEALTH
NC08453OtherBLUE CROSS/BLUE SHEILD
NC616607OtherAMERICAN CHIROPRACTIC NET
NC6416476001OtherCIGNA PPO
NC2684545OtherAETNA HMO
NC37243OtherPATRNERS
NC7108174OtherAETNA PPO
NC7908453Medicaid
NC2024315OtherFITSR HEALTH
NC08453OtherBLUE CROSS/BLUE SHEILD