Provider Demographics
NPI:1497828313
Name:ALL ABOUT POTENTIAL FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ALL ABOUT POTENTIAL FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOURIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-644-9074
Mailing Address - Street 1:211 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783
Mailing Address - Country:US
Mailing Address - Phone:605-644-9074
Mailing Address - Fax:605-722-0306
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783
Practice Address - Country:US
Practice Address - Phone:605-644-9074
Practice Address - Fax:605-722-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD936111N00000X
SD928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7604583Medicaid
SD7601312Medicaid
SD7604583Medicaid
U78776Medicare UPIN
U80051Medicare UPIN