Provider Demographics
NPI:1720619760
Name:PHILLIPS, STEPHEN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
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 1:6810 PARK HEIGHTS AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1662
Mailing Address - Country:US
Mailing Address - Phone:443-842-5500
Mailing Address - Fax:443-948-5694
Practice Address - Street 1:6810 PARK HEIGHTS AVE STE C4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1662
Practice Address - Country:US
Practice Address - Phone:443-842-5500
Practice Address - Fax:443-948-5694
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor