Provider Demographics
NPI:1497925069
Name:SPLITROCK CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:SPLITROCK CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:AXEL
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-582-8825
Mailing Address - Street 1:314 S SPLITROCK BLVD
Mailing Address - Street 2:#1
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1679
Mailing Address - Country:US
Mailing Address - Phone:605-582-8825
Mailing Address - Fax:605-582-8827
Practice Address - Street 1:314 S SPLITROCK BLVD
Practice Address - Street 2:#1
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1679
Practice Address - Country:US
Practice Address - Phone:605-582-8825
Practice Address - Fax:605-582-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1031111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDU94987Medicare UPIN
SDS41929Medicare PIN