Provider Demographics
NPI:1578266482
Name:PHILLIPS, MICHAELA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 N 16TH ST E
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3008
Mailing Address - Country:US
Mailing Address - Phone:307-222-9119
Mailing Address - Fax:
Practice Address - Street 1:500 E FREMONT AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4409
Practice Address - Country:US
Practice Address - Phone:307-222-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor