Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1907 | OK |
N | 111NN0400X | Neurology | 1907 | OK |
N | 111NR0400X | Rehabilitation Chiropractor | 1907 | OK |
NPI | 1598760258 |
---|---|
Provider Name | Frederick B Phillips JR. |
First Address | Lawton, OK 73505-3634 |
Second Address | Lawton, OK 73505-3634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 26/04/2012 |