MEDICARE: DR. PETER G. PHILLIPS, PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002231	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00261964	OTHER	WA	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1043403413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. PETER G. PHILLIPS, PS

Provider Business Mailing Address
First Line	:	8308 E MILL PLAIN BLVD
Second Line	:	102
City	:	VANCOUVER
State	:	WA
Zip	:	98664-2007
Country	:	US
Telephone Number	:	360-694-1118
Fax Number	:	360-694-1979

Provider Business Practice Location Address
First Line	:	8308 E MILL PLAIN BLVD
Second Line	:	102
City	:	VANCOUVER
State	:	WA
Zip	:	98664-2007
Country	:	US
Telephone Number	:	360-694-1118
Fax Number	:	360-694-1979

Authorized Official
Title or Position	:	CEO
Name	:	DR. PETER GEORGE PHILLIPS
Credential	:	D.C.
Telephone Number	:	360-694-1118

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	04/02/2008

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