1598762684 NPI number — HEALTHFIRST CHIROPRACTIC OF MILBANK

Table of content: (NPI 1598762684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598762684 NPI number — HEALTHFIRST CHIROPRACTIC OF MILBANK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHFIRST CHIROPRACTIC OF MILBANK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRO HEALTH AND WELLNESS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598762684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILBANK
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57252-0230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-432-9561
Provider Business Mailing Address Fax Number:
605-432-9562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 E 4TH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MILBANK
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57252-1543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-432-9561
Provider Business Practice Location Address Fax Number:
605-432-9562
Provider Enumeration Date:
07/05/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERGQUIST
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
605-432-9561

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  767 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9202986 . This is a "GROUP # DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0040599 . This is a "GROUP # WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0040600 . This is a "WELLMARK - DR. BERGQUIST" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 085M9PR . This is a "GROUP #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 086M0BE . This is a "BCBS - DR. BERGQUIST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7603903 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: C767 . This is a "DAKOTACARE - DR. BERGQUIS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 7601680 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".