Provider Demographics
NPI:1841204344
Name:PHILLIPS, GEORGE W (DC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:PHILLIPS
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 1:253 S CANFIELD-NILES RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515
Mailing Address - Country:US
Mailing Address - Phone:330-793-6790
Mailing Address - Fax:330-793-6794
Practice Address - Street 1:253 S CANFIELD-NILES RD
Practice Address - Street 2:UNIT B
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515
Practice Address - Country:US
Practice Address - Phone:330-793-6790
Practice Address - Fax:330-793-6794
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2009196Medicaid
OH0837201Medicare ID - Type Unspecified
U68332Medicare UPIN