Provider Demographics
NPI:1114485497
Name:PHILLIPS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PHILLIPS CHIROPRACTIC, PLLC
Other - Org Name:PHILLIPS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-639-4849
Mailing Address - Street 1:80 COUNTY ROAD 124
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2468
Mailing Address - Country:US
Mailing Address - Phone:512-639-4849
Mailing Address - Fax:
Practice Address - Street 1:1520 LEANDER RD STE 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8842
Practice Address - Country:US
Practice Address - Phone:512-639-4849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPS CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-06
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center