Provider Demographics
NPI:1538449483
Name:PHIPPS, PAUL (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PHIPPS
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 1:10896 HAMILTON PASS
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9494
Mailing Address - Country:US
Mailing Address - Phone:317-408-0723
Mailing Address - Fax:
Practice Address - Street 1:10896 HAMILTON PASS
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9494
Practice Address - Country:US
Practice Address - Phone:317-408-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor