Provider Demographics
NPI:1992903868
Name:PHILLIPS, CAROL JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 MOUNT HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5146
Mailing Address - Country:US
Mailing Address - Phone:410-626-7436
Mailing Address - Fax:
Practice Address - Street 1:977 MOUNT HOLLY DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5146
Practice Address - Country:US
Practice Address - Phone:410-626-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor