Justin Ray Phillips, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3465 Issued in OK

Practice address

602 N. Broadway
Teucumseh, OK 74873

Phone

(405) 598-6768

Fax

(405) 598-6770

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Oklahoma Chiropractic Clinic Inc

  • Chiropractor
  • Tecumseh, OK
  • NPI 1174714877
  Medicare reassignment NPD Authorized official
• Olive Branch Behavioral Health Counseling Services, Inc

  • Counselor
  • Tecumseh, OK
  • NPI 1538657572
  NPD (past)

Specialty

Chiropractic

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295821874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 N. BROADWAY",
            "address_2": "PO BOX 589",
            "city": "TEUCUMSEH",
            "state": "OK",
            "postal_code": "74873",
            "telephone_number": "405-598-6768",
            "fax_number": "405-598-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N. BROADWAY",
            "city": "TEUCUMSEH",
            "state": "OK",
            "postal_code": "74873",
            "telephone_number": "405-598-6768",
            "fax_number": "405-598-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "JUSTIN",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.