Provider Demographics
NPI:1588644678
Name:PHELTS, JOHN WESLY III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLY
Last Name:PHELTS
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:124 E 40TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1723
Mailing Address - Country:US
Mailing Address - Phone:212-286-2012
Mailing Address - Fax:212-283-8323
Practice Address - Street 1:124 E 40TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1723
Practice Address - Country:US
Practice Address - Phone:212-286-2012
Practice Address - Fax:212-283-8323
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor