Provider Demographics
NPI:1326336215
Name:HUISMAN, MICHAEL CODY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CODY
Last Name:HUISMAN
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 1:117 E HOLLY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1131
Mailing Address - Country:US
Mailing Address - Phone:605-582-8800
Mailing Address - Fax:605-582-8820
Practice Address - Street 1:117 E HOLLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1131
Practice Address - Country:US
Practice Address - Phone:605-582-8800
Practice Address - Fax:605-582-8820
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor