Provider Demographics
NPI:1629178322
Name:OLLIS, PHILLIP C (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:C
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 1:10110 MONTWOOD DR
Mailing Address - Street 2:SUITES F-G
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6244
Mailing Address - Country:US
Mailing Address - Phone:915-592-5800
Mailing Address - Fax:915-592-5800
Practice Address - Street 1:10110 MONTWOOD DR
Practice Address - Street 2:SUITES F-G
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6244
Practice Address - Country:US
Practice Address - Phone:915-592-5800
Practice Address - Fax:915-592-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600774Medicare ID - Type Unspecified