Provider Demographics
NPI:1114164613
Name:PHILLIPS, MICHAEL WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:PHILLIPS
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 1:1601 E LAMAR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4510
Mailing Address - Country:US
Mailing Address - Phone:817-801-5111
Mailing Address - Fax:817-801-5222
Practice Address - Street 1:1601 E LAMAR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4510
Practice Address - Country:US
Practice Address - Phone:817-801-5111
Practice Address - Fax:817-801-5222
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8069111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition