Provider Demographics
NPI:1194094292
Name:PHILLIPSBURG CHIROPRACTIC CENTER, PA
Entity type:Organization
Organization Name:PHILLIPSBURG CHIROPRACTIC CENTER, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-543-2700
Mailing Address - Street 1:875 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-1612
Mailing Address - Country:US
Mailing Address - Phone:785-543-2700
Mailing Address - Fax:785-540-4041
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:KS
Practice Address - Zip Code:67669-1932
Practice Address - Country:US
Practice Address - Phone:785-425-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPSBURG CHIROPRACTIC CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04824111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU95363Medicare UPIN