Provider Demographics
NPI:1497437438
Name:PHILLIPS, ANDREW C (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
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 1:55 NW WALL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3200
Mailing Address - Country:US
Mailing Address - Phone:541-389-4321
Mailing Address - Fax:541-389-4420
Practice Address - Street 1:55 NW WALL ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3200
Practice Address - Country:US
Practice Address - Phone:541-389-4321
Practice Address - Fax:541-389-4420
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor