NPIMap

Organization Active NPI

Phillips Chiropractic Clinic Inc PS

  • Chiropractor
  • Vancouver, WA
National Provider Identifier
1336354000
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
862 Issued in WA
Legal business name
PHILLIPS CHIROPRACTIC CLINIC INC PS
Practice address
6409 E Mill Plain Blvd
Vancouver, WA 98661-7454
Phone
(360) 693-2597
Fax
(360) 695-0272
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Jon Phillips, DC
Title
President
Phone
(360) 693-2597

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 862 WA Primary

Addresses

Primary practice location

6409 E Mill Plain Blvd
Vancouver, WA 98661-7454

Mailing address

6409 E Mill Plain Blvd
Vancouver, WA 98661-7454
Phone (360) 693-2597

Other identifiers 2

IdentifierTypeStateIssuer
0045101OtherWAL&I NUMBER
2708501MedicaidWA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336354000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6409 E MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617454",
            "telephone_number": "360-693-2597",
            "fax_number": "360-695-0272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6409 E MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617454",
            "telephone_number": "360-693-2597",
            "fax_number": "360-695-0272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIPS CHIROPRACTIC CLINIC INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-693-2597",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I NUMBER",
            "identifier": "0045101",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2708501",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.