Provider Demographics
NPI:1649359936
Name:WRIGHT, PHILIP LLOYD (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LLOYD
Last Name:WRIGHT
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 1:231 TWISTED TIMBER CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3782
Mailing Address - Country:US
Mailing Address - Phone:770-592-3552
Mailing Address - Fax:
Practice Address - Street 1:3745 CHEROKEE ST NW
Practice Address - Street 2:# 606
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6733
Practice Address - Country:US
Practice Address - Phone:770-795-3144
Practice Address - Fax:770-795-3142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor