Provider Demographics
NPI:1659366243
Name:PHILLIPS, KAREN (DC, LAC, RN)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DC, LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ATHERTON RD
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-3128
Mailing Address - Country:US
Mailing Address - Phone:781-825-3259
Mailing Address - Fax:
Practice Address - Street 1:4 BOUND BROOK CT
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1205
Practice Address - Country:US
Practice Address - Phone:781-545-8566
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MA2832111N00000X
MA219841171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH-Y45651Medicare ID - Type Unspecified