Provider Demographics
NPI:1013128768
Name:ALAN E. PHILLIPS
Entity Type:Organization
Organization Name:ALAN E. PHILLIPS
Other - Org Name:MONMOUTH CHIROPRACTIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-734-7050
Mailing Address - Street 1:312 E ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-1837
Mailing Address - Country:US
Mailing Address - Phone:309-734-7050
Mailing Address - Fax:309-734-4585
Practice Address - Street 1:312 E ARCHER AVE
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1837
Practice Address - Country:US
Practice Address - Phone:309-734-7050
Practice Address - Fax:309-734-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038004758Medicaid
IL9415004OtherBLUECROSS BLUESHIELD
IL=========OtherOTHER
IL=========OtherOTHER
IL696140Medicare PIN