Provider Demographics
NPI:1225488083
Name:PHILLIPS FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PHILLIPS FAMILY CHIROPRACTIC LLC
Other - Org Name:BRANDON CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-631-8808
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-4675
Mailing Address - Country:US
Mailing Address - Phone:205-631-8808
Mailing Address - Fax:205-631-8832
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-4675
Practice Address - Country:US
Practice Address - Phone:205-631-8808
Practice Address - Fax:205-631-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty