Provider Demographics
NPI:1942568373
Name:PHIPPS, ERIC ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALAN
Last Name:PHIPPS
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:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-0541
Mailing Address - Country:US
Mailing Address - Phone:479-224-6500
Mailing Address - Fax:479-795-2177
Practice Address - Street 1:331 COMMERCIAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9791
Practice Address - Country:US
Practice Address - Phone:479-244-6500
Practice Address - Fax:479-795-2177
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6858111N00000X
AR16017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA106963Medicare UPIN