Provider Demographics
NPI:1992798359
Name:ENG, PHILLIP (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:ENG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TRIAD CHIROPRACTIC
Other - Middle Name:
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:941 NORDICA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4212
Mailing Address - Country:US
Mailing Address - Phone:213-507-6617
Mailing Address - Fax:
Practice Address - Street 1:941 NORDICA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4212
Practice Address - Country:US
Practice Address - Phone:213-507-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14017111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14017Medicare UPIN