1720273758 NPI number — STRAIN CHIROPRACTIC CLINIC, PROF. LLC

Table of content: (NPI 1720273758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720273758 NPI number — STRAIN CHIROPRACTIC CLINIC, PROF. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRAIN CHIROPRACTIC CLINIC, PROF. LLC
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:
Provider Other Organization Name Type Code:
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:
1720273758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57702-0906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-718-5720
Provider Business Mailing Address Fax Number:
605-718-5721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57702-0906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-718-5720
Provider Business Practice Location Address Fax Number:
605-718-5721
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRAIN
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
STERZINGER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-718-5720

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  SD 1004 , 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)





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