Provider Demographics
NPI:1154491173
Name:PHILLIPS, JAY B (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
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 1:6843 N ORACLE RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4280
Mailing Address - Country:US
Mailing Address - Phone:520-575-0929
Mailing Address - Fax:520-575-0939
Practice Address - Street 1:6843 N ORACLE RD
Practice Address - Street 2:SUITE 17
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4280
Practice Address - Country:US
Practice Address - Phone:520-575-0929
Practice Address - Fax:520-575-0939
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107783Medicare ID - Type Unspecified