Provider Demographics
NPI:1861657512
Name:ANTHONY PHILLIPS, DC, PA
Entity Type:Organization
Organization Name:ANTHONY PHILLIPS, DC, PA
Other - Org Name:INSIDE SPORTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA
Authorized Official - Phone:913-888-4845
Mailing Address - Street 1:11301 W 88TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1703
Mailing Address - Country:US
Mailing Address - Phone:913-888-4548
Mailing Address - Fax:913-888-9248
Practice Address - Street 1:11301 W 88TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1703
Practice Address - Country:US
Practice Address - Phone:913-888-4845
Practice Address - Fax:913-888-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104294111NS0005X
MO2006021696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0009096Medicare PIN
MOT07E636Medicare PIN