Provider Demographics
NPI:1023117744
Name:PHILLIPS, STEPHEN BRUCE (LAC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BRUCE
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2627 LA MESA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0336
Mailing Address - Country:US
Mailing Address - Phone:916-486-9600
Mailing Address - Fax:916-486-3666
Practice Address - Street 1:2627 LA MESA WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0336
Practice Address - Country:US
Practice Address - Phone:916-486-9600
Practice Address - Fax:916-486-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3663171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist