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General NPI Number Information
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NPI Number | 1699110437
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Entity Type | Organization
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Legal Business Name | PHILLIPS CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 4045 VINEVILLE AVE
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City | MACON
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State | GA
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Zip | 31210-5039
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Country | US
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Telephone | 478-475-4131
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Fax | 475-475-4128
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Provider Business Mailing Address
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Address Line | 4045 VINEVILLE AVE
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City | MACON
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State | GA
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Zip | 31210-5039
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Country | US
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Telephone | 478-475-4131
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Fax | 475-475-4128
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES BAILEY PHILLIPS JR.
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Credential | D.C.
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Telephone | 478-475-4131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 006566
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License Number State | GA
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