Healthcare Provider Details

I. General information

NPI: 1114164613
Provider Name (Legal Business Name): MICHAEL WAYNE PHILLIPS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E LAMAR BLVD SUITE 100
ARLINGTON TX
76011-4510
US

IV. Provider business mailing address

1601 E LAMAR BLVD SUITE 100
ARLINGTON TX
76011-4510
US

V. Phone/Fax

Practice location:
  • Phone: 817-801-5111
  • Fax: 817-801-5222
Mailing address:
  • Phone: 817-801-5111
  • Fax: 817-801-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number8069
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: