Provider Demographics
NPI:1528403466
Name:DOBESH CHIROPRACTIC PROF LLC
Entity Type:Organization
Organization Name:DOBESH CHIROPRACTIC PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DOBESH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-996-1160
Mailing Address - Street 1:1415 W HAVENS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4102
Mailing Address - Country:US
Mailing Address - Phone:605-996-1160
Mailing Address - Fax:605-996-6433
Practice Address - Street 1:1415 W HAVENS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4102
Practice Address - Country:US
Practice Address - Phone:605-996-1160
Practice Address - Fax:605-996-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty