Provider Demographics
NPI:1285198259
Name:MY CHIROPRACTIC, PROF., LLC
Entity Type:Organization
Organization Name:MY CHIROPRACTIC, PROF., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MUNSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-693-3405
Mailing Address - Street 1:3405 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4417
Mailing Address - Country:US
Mailing Address - Phone:605-693-3405
Mailing Address - Fax:605-693-3404
Practice Address - Street 1:3405 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-4417
Practice Address - Country:US
Practice Address - Phone:605-693-3405
Practice Address - Fax:605-693-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty