Provider Demographics
NPI:1568572311
Name:PHILLIPS, JEFFREY PAUL (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
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 1:375 W MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95698
Mailing Address - Country:US
Mailing Address - Phone:530-666-2526
Mailing Address - Fax:530-666-5991
Practice Address - Street 1:375 W MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-666-2526
Practice Address - Fax:530-666-5991
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT38797Medicare ID - Type Unspecified
T38797Medicare UPIN