MEDICARE: NICHOLAS J PHILLIPS 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	111N00000X	Chiropractor	1807	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417951831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS J PHILLIPS D.C.

Provider Business Mailing Address
First Line	:	5 PUBLIC SQ
Second Line	:
City	:	GALION
State	:	OH
Zip	:	44833-1926
Country	:	US
Telephone Number	:	419-468-4555
Fax Number	:	419-468-0005

Provider Business Practice Location Address
First Line	:	5 PUBLIC SQ
Second Line	:
City	:	GALION
State	:	OH
Zip	:	44833-1926
Country	:	US
Telephone Number	:	419-468-4555
Fax Number	:	419-468-0005

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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