Provider Demographics
NPI:1447394663
Name:PHILLIPS, THOMAS D (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
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 1:1201 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6725
Mailing Address - Country:US
Mailing Address - Phone:575-434-2415
Mailing Address - Fax:575-434-2415
Practice Address - Street 1:1201 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6725
Practice Address - Country:US
Practice Address - Phone:575-434-2415
Practice Address - Fax:575-434-2415
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMKC99OtherBLUE CROSS BLUE SHIELD
NMKC99OtherBLUE CROSS BLUE SHIELD
NMNM400086Medicare UPIN