MEDICARE: PHILLIPS CHIROPRACTIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	11-03352	KS
2	261QP2000X	Physical Therapy Clinic/Center	11-04738	KS
3	111N00000X	Chiropractor	01-04908

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508138280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIPS CHIROPRACTIC, PA

Provider Business Mailing Address
First Line	:	1909 N 14TH AVE
Second Line	:	SUITE C
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2364
Country	:	US
Telephone Number	:	620-338-8633
Fax Number	:	620-338-8121

Provider Business Practice Location Address
First Line	:	1909 N 14TH AVE
Second Line	:	SUITE C
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2364
Country	:	US
Telephone Number	:	620-338-8633
Fax Number	:	620-338-8121

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMMIE D PHILLIPS
Credential	:	D.C.
Telephone Number	:	620-225-4139

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	09/14/2016

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Directions to “PHILLIPS CHIROPRACTIC, PA ” Practice Location

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