Provider Demographics
NPI:1376721647
Name:CHIROPRACTIC CENTER FOR HEALTHY LIVING PC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER FOR HEALTHY LIVING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MULLENMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-996-1160
Mailing Address - Street 1:1415 WEST HAVENS STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4116
Mailing Address - Country:US
Mailing Address - Phone:605-996-1160
Mailing Address - Fax:605-996-6433
Practice Address - Street 1:1415 WEST HAVENS STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4116
Practice Address - Country:US
Practice Address - Phone:605-996-1160
Practice Address - Fax:605-996-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1039111N00000X
SD1040111NN0400X
FL050115111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDSD00722OtherEID
SD42563OtherGROUP PIN
SDV01733Medicare UPIN
SDV01732Medicare UPIN
SD42563OtherGROUP PIN
SDS42565Medicare PIN