Provider Demographics
NPI:1508478934
Name:DARGATZ, ALLISON A (DC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:A
Last Name:DARGATZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 13TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7900
Mailing Address - Country:US
Mailing Address - Phone:605-881-7057
Mailing Address - Fax:
Practice Address - Street 1:611 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4938
Practice Address - Country:US
Practice Address - Phone:605-882-0100
Practice Address - Fax:605-882-6911
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor