Provider Demographics
NPI:1114362183
Name:PHILLIP, JAMES ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALEXANDER
Last Name:PHILLIP
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 1:1022 DEER VLY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-9482
Mailing Address - Country:US
Mailing Address - Phone:517-403-7128
Mailing Address - Fax:
Practice Address - Street 1:108 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ONSTED
Practice Address - State:MI
Practice Address - Zip Code:49265-9455
Practice Address - Country:US
Practice Address - Phone:517-467-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69310006Medicare PIN