Provider Demographics
NPI:1164590758
Name:BLACK HILLS HEALTH AND WELLNESS CENTER OF RAPID CI
Entity Type:Organization
Organization Name:BLACK HILLS HEALTH AND WELLNESS CENTER OF RAPID CI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIBERDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-341-7500
Mailing Address - Street 1:1220 MT RUSHMORE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-341-7500
Mailing Address - Fax:605-341-7903
Practice Address - Street 1:1220 MT RUSHMORE RD
Practice Address - Street 2:STE 1
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-341-7500
Practice Address - Fax:605-341-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0004738OtherBLUE CROSS BLUE SHIELD
41557Medicare ID - Type Unspecified
SD6526690001Medicare NSC