=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699187542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILLIP FAMILY CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2014
-----------------------------------------------------
Last Update Date | 10/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1171 S MAIN ST STE 5
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-562-2381
-----------------------------------------------------
Fax | 734-562-2582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1171 S MAIN ST STE 5
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-562-2381
-----------------------------------------------------
Fax | 734-562-2582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES ALEXANDER PHILLIP
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 734-562-2381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301010015
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------