Provider Demographics
NPI:1457672255
Name:MURRAY CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:MURRAY CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:605-697-5090
Mailing Address - Street 1:750 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2822
Mailing Address - Country:US
Mailing Address - Phone:605-697-5090
Mailing Address - Fax:605-697-5090
Practice Address - Street 1:750 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2822
Practice Address - Country:US
Practice Address - Phone:605-697-5090
Practice Address - Fax:605-697-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3K028MUOtherBLUE CROSS BLUE SHIELD OF MN
SD0080133OtherWELLMARK BLUE CROSS BLUE SHIELD
SDCASD2OtherSANFORD
SDCASD1OtherDAKOTACARE
NDS80133Medicare PIN