Provider Demographics
NPI:1033626114
Name:CHIROSPORT HARTFORD, PC
Entity Type:Organization
Organization Name:CHIROSPORT HARTFORD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-759-3125
Mailing Address - Street 1:6705 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8585
Mailing Address - Country:US
Mailing Address - Phone:605-334-6656
Mailing Address - Fax:605-271-7616
Practice Address - Street 1:700 N VANDEMARK AVE STE 106
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-2317
Practice Address - Country:US
Practice Address - Phone:605-759-3125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty