Provider Demographics
NPI:1568563377
Name:PHILLIPS, ROBERT A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
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 1:1555 COVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-2830
Mailing Address - Country:US
Mailing Address - Phone:937-615-1111
Mailing Address - Fax:937-615-1110
Practice Address - Street 1:1555 COVINGTON AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2830
Practice Address - Country:US
Practice Address - Phone:937-615-1111
Practice Address - Fax:937-615-1110
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31121375Medicaid
OH85636Medicare UPIN
OH31121375Medicaid