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General NPI Number Information
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NPI Number | 1184853350
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Entity Type | Individual
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Provider Name | JUSTIN PHILLIPS LAC.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 911 W 38TH ST 200T
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City | AUSTIN
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State | TX
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Zip | 78705-1188
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Country | US
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Telephone | 512-344-6223
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Fax |
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Provider Business Mailing Address
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Address Line | 11266 TAYLOR DRAPER LN 1422
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City | AUSTIN
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State | TX
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Zip | 78759-2466
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Country | US
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Telephone | 512-673-0617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01134
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License Number State | TX
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