Provider Demographics
NPI:1093951550
Name:CLITES, STEVEN MICHEL (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHEL
Last Name:CLITES
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 1:1222 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2804
Mailing Address - Country:US
Mailing Address - Phone:605-696-7222
Mailing Address - Fax:605-692-6624
Practice Address - Street 1:1222 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-0850
Practice Address - Country:US
Practice Address - Phone:605-696-7222
Practice Address - Fax:605-692-6624
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS103131Medicare PIN