Provider Demographics
NPI:1225058860
Name:BLICKENSDERFER, WILLIAM C (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:BLICKENSDERFER
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 1:2326 CANYON LAKE DR
Mailing Address - Street 2:STE 7
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2913
Mailing Address - Country:US
Mailing Address - Phone:605-343-1113
Mailing Address - Fax:605-342-8424
Practice Address - Street 1:2326 CANYON LAKE DR
Practice Address - Street 2:STE 7
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2913
Practice Address - Country:US
Practice Address - Phone:605-343-1113
Practice Address - Fax:605-342-8424
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS6076OtherMEDICARE B
SD0006076OtherBLUE CROSS BLUE SHIELD
SD7603190Medicaid
SD6076Medicare ID - Type Unspecified
SD7603190Medicaid