Provider Demographics
NPI:1215026455
Name:OLLIS, PHILIP EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EVAN
Last Name:OLLIS
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 1:1455 CEDAR ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-7700
Mailing Address - Country:US
Mailing Address - Phone:812-284-2225
Mailing Address - Fax:812-284-3872
Practice Address - Street 1:1455 CEDAR ST STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-7700
Practice Address - Country:US
Practice Address - Phone:812-284-2225
Practice Address - Fax:812-284-3872
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002539A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
00X274O01Medicare PIN