Healthcare Provider Details

I. General information

NPI: 1902079692
Provider Name (Legal Business Name): PHILLIPS CHIROPRACTIC ,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 NW CACHE RD
LAWTON OK
73505-3634
US

IV. Provider business mailing address

4010 NW CACHE RD
LAWTON OK
73505-3634
US

V. Phone/Fax

Practice location:
  • Phone: 580-357-8688
  • Fax: 580-357-7483
Mailing address:
  • Phone: 580-357-8688
  • Fax: 580-357-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1907
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1907
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1907
License Number StateOK

VIII. Authorized Official

Name: FREDERICK B. PHILLIPS JR.
Title or Position: OWNER/PHYSICIAN
Credential: D.C.
Phone: 580-357-8688