Provider Demographics
NPI:1083629448
Name:PHILLIPS, SUE V (DC)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:V
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 ADDISON AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5343
Mailing Address - Country:US
Mailing Address - Phone:208-735-2442
Mailing Address - Fax:208-735-9030
Practice Address - Street 1:1625 ADDISON AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5343
Practice Address - Country:US
Practice Address - Phone:208-735-2442
Practice Address - Fax:208-735-9030
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 761111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1673292Medicare ID - Type Unspecified