MEDICARE: DR. RALEIGH PHILLIPS D.C.

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	1030	SC

General Provider Information

NPI Number	:	1538132618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALEIGH PHILLIPS D.C.

Provider Business Mailing Address
First Line	:	19 SHELTER COVE LN
Second Line	:	SUITE 106
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-3520
Country	:	US
Telephone Number	:	843-686-2225
Fax Number	:	843-686-6103

Provider Business Practice Location Address
First Line	:	19 SHELTER COVE LN
Second Line	:	SUITE 106
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-3520
Country	:	US
Telephone Number	:	843-686-2225
Fax Number	:	843-686-6103

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	09/01/2010

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