Provider Demographics
NPI:1558466169
Name:PHILLIPS, JAMMIE D (D C)
Entity Type:Individual
Prefix:DR
First Name:JAMMIE
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:NESS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67560-0512
Mailing Address - Country:US
Mailing Address - Phone:785-798-3915
Mailing Address - Fax:785-798-3916
Practice Address - Street 1:2601 CENTRAL AVE
Practice Address - Street 2:VILLAGE SQUARE MALL
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6200
Practice Address - Country:US
Practice Address - Phone:620-225-4139
Practice Address - Fax:620-225-4286
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 4908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKS4908OtherKANSAS LICENSE NO
KSKS4908OtherKANSAS LICENSE NO
KS062124Medicare ID - Type Unspecified