Provider Demographics
NPI:1326168824
Name:PHILLIPS, KARYN M (DC)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:515 HERRICKS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1399
Mailing Address - Country:US
Mailing Address - Phone:516-294-3605
Mailing Address - Fax:516-294-3606
Practice Address - Street 1:515 HERRICKS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1399
Practice Address - Country:US
Practice Address - Phone:516-294-3605
Practice Address - Fax:516-294-3606
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005975111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX41421Medicare UPIN