Provider Demographics
NPI:1174677439
Name:DAKOTA LIFE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DAKOTA LIFE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-334-0900
Mailing Address - Street 1:600 W COVENTARY CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2512
Mailing Address - Country:US
Mailing Address - Phone:605-334-0900
Mailing Address - Fax:605-334-0910
Practice Address - Street 1:5109 S CLIFF AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2512
Practice Address - Country:US
Practice Address - Phone:605-334-0900
Practice Address - Fax:605-334-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty