Healthcare Provider Details

I. General information

NPI: 1861657512
Provider Name (Legal Business Name): ANTHONY PHILLIPS, DC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 W 88TH ST STE 100
OVERLAND PARK KS
66214-1703
US

IV. Provider business mailing address

11301 W 88TH ST STE 100
OVERLAND PARK KS
66214-1703
US

V. Phone/Fax

Practice location:
  • Phone: 913-888-4845
  • Fax: 913-888-9248
Mailing address:
  • Phone: 913-888-4548
  • Fax: 913-888-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104294
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006021696
License Number StateMO

VIII. Authorized Official

Name: DR. ANTHONY S PHILLIPS
Title or Position: CLINIC DIRECTOR/PHYSICIAN
Credential: D.C, PA
Phone: 913-888-4845