Provider Demographics
NPI:1538132618
Name:PHILLIPS, RALEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:RALEIGH
Middle Name:
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 1:19 SHELTER COVE LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3520
Mailing Address - Country:US
Mailing Address - Phone:843-686-2225
Mailing Address - Fax:843-686-6103
Practice Address - Street 1:19 SHELTER COVE LN
Practice Address - Street 2:SUITE 106
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3520
Practice Address - Country:US
Practice Address - Phone:843-686-2225
Practice Address - Fax:843-686-6103
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT250160281Medicare ID - Type UnspecifiedMEDICARE
SC570823757Medicare UPIN