MEDICARE: DR. MARIEL K PHILLIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DCP00577	RI

General Provider Information

NPI Number	:	1407003304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIEL K PHILLIP

Provider Business Mailing Address
First Line	:	1243 MINERAL AVE
Second Line	:	UNIT 201
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-1226
Country	:	US
Telephone Number	:	401-952-0369
Fax Number	:	401-475-6060

Provider Business Practice Location Address
First Line	:	1243 MINERAL SPRING AVE 201
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4636
Country	:	US
Telephone Number	:	401-952-0369
Fax Number	:	401-475-6060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	07/23/2015

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