Sitsadaphone Phetchamphone, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038-010281 Issued in IL

Practice address

1157 W 18TH St
Chicago, IL 60608

Phone

(312) 344-1632

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1780739284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1157 W 18TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082387",
            "telephone_number": "312-344-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1157 W 18TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60608",
            "telephone_number": "312-344-1632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "504 Legacy Plz W",
            "address_2": "LA Porte",
            "address_purpose": "LOCATION",
            "city": "LA Porte",
            "state": "IN",
            "postal_code": "463505254",
            "country_code": "US",
            "telephone_number": "219-326-7246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHETCHAMPHONE",
        "first_name": "SITSADAPHONE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010281",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-010281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2232625",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Guccione Phelps, D.O.
• Ora Ashley Phelps, LCSW
• Paul Owen Phelps, M.D.
• Richard Ladd Phelps, MD
• Phenomenal Cradles Doula LLC.
• Phoxay Phetthongsy, D.C.
• Ngoc-Tuyen Thi Phi, DDS
• Phil S. Lebovitz, M.D., S.C.
• Shannon Alison Eileene Philander, M.D.
• Alexander Herbert Philbrick, PHARM.D.

• Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; 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.