1306028667 NPI number — ODLAND CHIROPRACTIC CLINIC PC

Table of content: (NPI 1306028667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306028667 NPI number — ODLAND CHIROPRACTIC CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODLAND CHIROPRACTIC CLINIC PC
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:
1306028667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 S MARION RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57106-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-361-2500
Provider Business Mailing Address Fax Number:
605-362-1930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 S MARION RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57106-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-361-2500
Provider Business Practice Location Address Fax Number:
605-362-1930
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ODLAND
Authorized Official First Name:
RICK
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
605-361-2500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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