Provider Demographics
NPI:1235729617
Name:NORTHERN PEAK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NORTHERN PEAK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-878-0167
Mailing Address - Street 1:600 5TH ST SE STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4915
Mailing Address - Country:US
Mailing Address - Phone:605-878-0167
Mailing Address - Fax:
Practice Address - Street 1:600 5TH ST SE STE 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4915
Practice Address - Country:US
Practice Address - Phone:605-878-0167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty