Healthcare Provider Details

I. General information

NPI: 1124280045
Provider Name (Legal Business Name): SUE V PHILLIPS DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 ADDISON AVE E
TWIN FALLS ID
83301-5343
US

IV. Provider business mailing address

1625 ADDISON AVE E
TWIN FALLS ID
83301-5343
US

V. Phone/Fax

Practice location:
  • Phone: 208-735-2442
  • Fax: 208-735-9030
Mailing address:
  • Phone: 208-735-2442
  • Fax: 208-735-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SUE V PHILLIPS
Title or Position: DR/OWNER
Credential: DC
Phone: 208-735-2442