Provider Demographics
NPI:1720705510
Name:BENJAMIN M. PHILLIPS DC PA
Entity Type:Organization
Organization Name:BENJAMIN M. PHILLIPS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-595-3312
Mailing Address - Street 1:2109 W HUNTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2833
Mailing Address - Country:US
Mailing Address - Phone:479-751-7771
Mailing Address - Fax:
Practice Address - Street 1:2109 W HUNTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2833
Practice Address - Country:US
Practice Address - Phone:479-751-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty