Provider Demographics
NPI:1770004855
Name:PHILLIPS CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:PHILLIPS CHIROPRACTIC, P.A.
Other - Org Name:PHILLIPS DURABLE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:ROTHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-225-4139
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1208
Mailing Address - Country:US
Mailing Address - Phone:620-225-4139
Mailing Address - Fax:620-225-4286
Practice Address - Street 1:311 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5614
Practice Address - Country:US
Practice Address - Phone:620-260-2199
Practice Address - Fax:620-260-2715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPS CHIROPRACTIC, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-29
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16-105450332B00000X
KS16-104621332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201173360AMedicaid
KS200631040AMedicaid