Healthcare Provider Details

I. General information

NPI: 1619258183
Provider Name (Legal Business Name): JUSTIN PHILLIPS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 LEE HWY SUITE 600
CHATTANOOGA TN
37421-1799
US

IV. Provider business mailing address

7000 LEE HWY SUITE 600
CHATTANOOGA TN
37421-1799
US

V. Phone/Fax

Practice location:
  • Phone: 423-894-0432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2524
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: