MEDICARE: PHILLIPS CHIROPRACTIC LLC

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	038011351	IL

General Provider Information

NPI Number	:	1497980494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIPS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2339 PONTOON RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2339 PONTOON RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4022
Country	:	US
Telephone Number	:	618-931-2050
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. JAMES THOMAS PHILLIPS
Credential	:	DC
Telephone Number	:	618-931-2050

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	05/19/2009

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