Provider Demographics
NPI:1225037872
Name:DEBOER, ROSS JON (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JON
Last Name:DEBOER
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 1:5132 S CLIFF AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5437
Mailing Address - Country:US
Mailing Address - Phone:605-275-2244
Mailing Address - Fax:
Practice Address - Street 1:5132 S CLIFF AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5437
Practice Address - Country:US
Practice Address - Phone:605-275-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-16
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1230111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU94936Medicare UPIN