Healthcare Provider Details

I. General information

NPI: 1508138280
Provider Name (Legal Business Name): PHILLIPS CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 N 14TH AVE SUITE C
DODGE CITY KS
67801-2364
US

IV. Provider business mailing address

1909 N 14TH AVE SUITE C
DODGE CITY KS
67801-2364
US

V. Phone/Fax

Practice location:
  • Phone: 620-338-8633
  • Fax: 620-338-8121
Mailing address:
  • Phone: 620-338-8633
  • Fax: 620-338-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04908
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number11-03352
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number11-04738
License Number StateKS

VIII. Authorized Official

Name: DR. JAMMIE D PHILLIPS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 620-225-4139