Provider Demographics
NPI:1245440460
Name:PHILLIPS, DAVID PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:P
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-0703
Mailing Address - Country:US
Mailing Address - Phone:507-214-2552
Mailing Address - Fax:
Practice Address - Street 1:8200 HUMBOLDT AVE S STE 204
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1432
Practice Address - Country:US
Practice Address - Phone:952-884-6144
Practice Address - Fax:952-884-9180
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor