Provider Demographics
NPI:1114953130
Name:ORTMAN CLINIC
Entity Type:Organization
Organization Name:ORTMAN CLINIC
Other - Org Name:ORTMAN CHIROPRACTIC CLINIC PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LON
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-296-3431
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:CANISTOTA
Mailing Address - State:SD
Mailing Address - Zip Code:57012-0157
Mailing Address - Country:US
Mailing Address - Phone:605-296-3431
Mailing Address - Fax:605-296-3565
Practice Address - Street 1:209 W MAIN
Practice Address - Street 2:
Practice Address - City:CANISTOTA
Practice Address - State:SD
Practice Address - Zip Code:57012
Practice Address - Country:US
Practice Address - Phone:605-296-3431
Practice Address - Fax:605-296-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3748Medicare ID - Type Unspecified