Provider Demographics
NPI:1063005312
Name:SPRUNK, DAWN R (LMT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:SPRUNK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13659 PASQUE FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:SD
Mailing Address - Zip Code:57751-6669
Mailing Address - Country:US
Mailing Address - Phone:701-866-3093
Mailing Address - Fax:
Practice Address - Street 1:2720 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8128
Practice Address - Country:US
Practice Address - Phone:605-391-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist