Provider Demographics
NPI:1124275136
Name:JEFFREY G PHILLIPS CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:JEFFREY G PHILLIPS CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-942-9505
Mailing Address - Street 1:967 S COAST HIGHWAY 101
Mailing Address - Street 2:B109
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4443
Mailing Address - Country:US
Mailing Address - Phone:760-942-9505
Mailing Address - Fax:
Practice Address - Street 1:967 S COAST HIGHWAY 101
Practice Address - Street 2:B109
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4443
Practice Address - Country:US
Practice Address - Phone:760-942-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty