Provider Demographics
NPI:1417078262
Name:PHYSICIAN'S CHIROPRACTIC SERVICES, INC
Entity Type:Organization
Organization Name:PHYSICIAN'S CHIROPRACTIC SERVICES, INC
Other - Org Name:THE CONKLIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-862-0800
Mailing Address - Street 1:15055 EAST FWY
Mailing Address - Street 2:SUITE C10
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4144
Mailing Address - Country:US
Mailing Address - Phone:281-862-0800
Mailing Address - Fax:281-862-0835
Practice Address - Street 1:15055 EAST FWY
Practice Address - Street 2:SUITE C10
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4144
Practice Address - Country:US
Practice Address - Phone:281-862-0800
Practice Address - Fax:281-862-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0089PLOtherBCBS GROUP#
TX0089PLOtherBCBS GROUP#