Provider Demographics
NPI:1215926340
Name:PHILLIPS, MERLE CLARK (DC)
Entity type:Individual
Prefix:DR
First Name:MERLE
Middle Name:CLARK
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E BRIDGE ST
Mailing Address - Street 2:P.O. BOX 507
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1801
Mailing Address - Country:US
Mailing Address - Phone:507-637-8585
Mailing Address - Fax:507-637-8649
Practice Address - Street 1:821 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1801
Practice Address - Country:US
Practice Address - Phone:507-637-8585
Practice Address - Fax:507-637-8649
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN575327900Medicaid
MN47215PHOtherBCBSMN
MN47215PHOtherBCBSMN
MN575327900Medicaid