Provider Demographics
NPI:1487818522
Name:PHILLIPS CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:PHILLIPS CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-225-4139
Mailing Address - Street 1:2200 SUMMERLON CIR STE D
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2905
Mailing Address - Country:US
Mailing Address - Phone:620-225-4139
Mailing Address - Fax:620-225-4286
Practice Address - Street 1:2200 SUMMERLON CIR STE D
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2905
Practice Address - Country:US
Practice Address - Phone:620-225-4139
Practice Address - Fax:620-225-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6318230001Medicare NSC