Provider Demographics
NPI:1306028667
Name:ODLAND CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:ODLAND CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-361-2500
Mailing Address - Street 1:3600 S MARION RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-1349
Mailing Address - Country:US
Mailing Address - Phone:605-361-2500
Mailing Address - Fax:605-362-1930
Practice Address - Street 1:3600 S MARION RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-1349
Practice Address - Country:US
Practice Address - Phone:605-361-2500
Practice Address - Fax:605-362-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD102280Medicare Oscar/Certification
SDS8402Medicare PIN
SD102304Medicare Oscar/Certification