Provider Demographics
NPI:1437261203
Name:PHILLIPS, RICKY D (DC)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:D
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 1:1925 SPRING ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-1619
Mailing Address - Country:US
Mailing Address - Phone:408-388-3441
Mailing Address - Fax:805-221-5276
Practice Address - Street 1:1925 SPRING ST UNIT B
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-1619
Practice Address - Country:US
Practice Address - Phone:805-721-0050
Practice Address - Fax:052-215-2768
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24558111N00000X
CA24558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU62913Medicare UPIN
CADC0245580Medicare PIN