Provider Demographics
NPI:1508098658
Name:VERMILLION CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:VERMILLION CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROOB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-624-9101
Mailing Address - Street 1:110 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3036
Mailing Address - Country:US
Mailing Address - Phone:605-624-9101
Mailing Address - Fax:605-624-7832
Practice Address - Street 1:110 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3036
Practice Address - Country:US
Practice Address - Phone:605-624-9101
Practice Address - Fax:605-624-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty