Provider Demographics
NPI:1447439930
Name:NICHOLAS J PHILLIPS DC INC
Entity type:Organization
Organization Name:NICHOLAS J PHILLIPS DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-468-4555
Mailing Address - Street 1:5 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1926
Mailing Address - Country:US
Mailing Address - Phone:419-468-4555
Mailing Address - Fax:419-468-0005
Practice Address - Street 1:5 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1926
Practice Address - Country:US
Practice Address - Phone:419-468-4555
Practice Address - Fax:419-468-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854777Medicaid
OH9317281Medicare PIN
OH0854777Medicaid