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General NPI Number Information
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NPI Number | 1992931430
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Entity Type | Organization
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Legal Business Name | JASON W. PHILLIPS, D.C., P.A.
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 2738 WINNETKA AVE N
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City | NEW HOPE
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State | MN
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Zip | 55427-2850
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Country | US
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Telephone | 763-546-8622
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Fax |
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Provider Business Mailing Address
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Address Line | 6929 AUTUMN TER
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-3310
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Country | US
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Telephone | 952-956-2999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON WENDELL PHILLIPS
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Credential | D.C.
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Telephone | 952-956-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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