Provider Demographics
NPI:1326183765
Name:PAUL, PHILLIP WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WADE
Last Name:PAUL
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 1:224 E MAIN ST
Mailing Address - Street 2:PO BOX 517
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-3723
Mailing Address - Country:US
Mailing Address - Phone:972-636-9008
Mailing Address - Fax:
Practice Address - Street 1:224 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-3723
Practice Address - Country:US
Practice Address - Phone:972-636-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6468111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80960YOtherBCBS
TX80960YOtherBCBS
TXU58821Medicare UPIN
TX605301Medicare ID - Type UnspecifiedLEGACY #