Provider Demographics
NPI:1508138280
Name:PHILLIPS CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:PHILLIPS CHIROPRACTIC, PA
Other - Org Name:PT WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMMIE
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 1:1909 N 14TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2364
Mailing Address - Country:US
Mailing Address - Phone:620-338-8633
Mailing Address - Fax:620-338-8121
Practice Address - Street 1:1909 N 14TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2364
Practice Address - Country:US
Practice Address - Phone:620-338-8633
Practice Address - Fax:620-338-8121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPS CHIROPRACTIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-27
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01-04908111N00000X
KS11-03352261QP2000X
KS11-04738261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200631040AMedicaid
KSKA1147Medicare PIN
KS200631040AMedicaid
KSKA114701Medicare PIN
KSKS1147002Medicare PIN
KSKA1147004Medicare PIN