Provider Demographics
NPI:1336111632
Name:PHILLIPS, LEANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LEANN
Other - Middle Name:
Other - Last Name:NEWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-0969
Mailing Address - Country:US
Mailing Address - Phone:256-757-0023
Mailing Address - Fax:256-757-3200
Practice Address - Street 1:4021 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-2645
Practice Address - Country:US
Practice Address - Phone:256-757-0023
Practice Address - Fax:256-757-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051528967OtherBCBS
AL693917OtherACN
ALV05110Medicare UPIN
AL693917OtherACN