Provider Demographics
NPI:1194890442
Name:PHILLIPSBURG CHIROPRACTIC CENTER, P.A.
Entity type:Organization
Organization Name:PHILLIPSBURG CHIROPRACTIC CENTER, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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:785-543-0625
Mailing Address - Street 1:330 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-2710
Mailing Address - Country:US
Mailing Address - Phone:785-543-0625
Mailing Address - Fax:
Practice Address - Street 1:742 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-1916
Practice Address - Country:US
Practice Address - Phone:785-543-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPSBURG CHIROPRACTIC CENTER, P.A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660047Medicare ID - Type UnspecifiedGROUP MC AND BCBS NUMBER