Provider Demographics
NPI:1043854383
Name:PHILLIPS, CHESTER (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 BARRETT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6643
Mailing Address - Country:US
Mailing Address - Phone:919-783-5300
Mailing Address - Fax:
Practice Address - Street 1:4040 BARRETT DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6643
Practice Address - Country:US
Practice Address - Phone:919-783-5300
Practice Address - Fax:919-783-5007
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist