MEDICARE: DR. PHILLIP WADE PAUL D.C.

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	111NS0005X	Sports Physician Chiropractor	6468	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80960Y	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1326183765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP WADE PAUL D.C.

Provider Business Mailing Address
First Line	:	224 E MAIN ST
Second Line	:	PO BOX 517
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-3723
Country	:	US
Telephone Number	:	972-636-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 E PALESTINE AVE
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-7329
Country	:	US
Telephone Number	:	903-729-4325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	04/08/2026

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Directions to “ DR. PHILLIP WADE PAUL D.C.” Practice Location

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