Provider Demographics
NPI:1083771083
Name:HUNGERFORD, CHAD JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JASON
Last Name:HUNGERFORD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 DERDALL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2851
Mailing Address - Country:US
Mailing Address - Phone:605-697-5145
Mailing Address - Fax:605-697-5135
Practice Address - Street 1:2218 DERDALL DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2851
Practice Address - Country:US
Practice Address - Phone:605-697-5145
Practice Address - Fax:605-697-5135
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD879SD111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4245OtherSVHP PROVIDER NUMBER
SD0007727OtherBCBS OF SD PROVIDER NUMBE
SD4245OtherSVHP PROVIDER NUMBER
SD350054169Medicare PIN
SDS7727Medicare PIN
SD0007727OtherBCBS OF SD PROVIDER NUMBE