Provider Demographics
NPI:1518054287
Name:PHILLIPS, JASON L (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
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 1:830 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-7774
Mailing Address - Country:US
Mailing Address - Phone:828-277-7417
Mailing Address - Fax:
Practice Address - Street 1:830 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28813
Practice Address - Country:US
Practice Address - Phone:828-277-7417
Practice Address - Fax:828-277-7416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
085115OtherBCBS NC
U89768Medicare UPIN
085115OtherBCBS NC