Provider Demographics
NPI:1356510812
Name:HUNGERFORD CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HUNGERFORD CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:HUNGERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-697-5145
Mailing Address - Street 1:2218 DERDALL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2851
Mailing Address - Country:US
Mailing Address - Phone:605-697-5145
Mailing Address - Fax:605-697-5135
Practice Address - Street 1:2218 DERDALL DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2851
Practice Address - Country:US
Practice Address - Phone:605-697-5145
Practice Address - Fax:605-697-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD879 SD111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4245OtherSANFORD HEALTH PLAN
SD600095OtherMEDICA
SDC879OtherDAKOTACARE