Healthcare Provider Details

I. General information

NPI: 1417078262
Provider Name (Legal Business Name): PHYSICIAN'S CHIROPRACTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 EAST FWY SUITE C10
CHANNELVIEW TX
77530-4144
US

IV. Provider business mailing address

15055 EAST FWY SUITE C10
CHANNELVIEW TX
77530-4144
US

V. Phone/Fax

Practice location:
  • Phone: 281-862-0800
  • Fax: 281-862-0835
Mailing address:
  • Phone: 281-862-0800
  • Fax: 281-862-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6146
License Number StateTX

VIII. Authorized Official

Name: DR. PHILIP DANIEL CONKLIN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 281-862-0800