Provider Demographics
NPI:1881728673
Name:PHILLIPS, KATHY (DC)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 GOLF COURSE RD SE STE C
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1628
Mailing Address - Country:US
Mailing Address - Phone:505-220-3031
Mailing Address - Fax:505-896-3242
Practice Address - Street 1:2105 GOLF COURSE RD SE STE C
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1628
Practice Address - Country:US
Practice Address - Phone:505-220-3031
Practice Address - Fax:505-896-3242
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01KJ52OtherBLUE CROSS BLUE SHEILD
NM341415310Medicare ID - Type Unspecified
NMNM01KJ52OtherBLUE CROSS BLUE SHEILD