Healthcare Provider Details

I. General information

NPI: 1992931430
Provider Name (Legal Business Name): JASON W. PHILLIPS, D.C., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2738 WINNETKA AVE N
NEW HOPE MN
55427-2850
US

IV. Provider business mailing address

6929 AUTUMN TER
EDEN PRAIRIE MN
55346-3310
US

V. Phone/Fax

Practice location:
  • Phone: 763-546-8622
  • Fax:
Mailing address:
  • Phone: 952-956-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON WENDELL PHILLIPS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 952-956-2999