Provider Demographics
NPI:1558347443
Name:MCDANIEL, ROSS A (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:A
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3245
Mailing Address - Country:US
Mailing Address - Phone:605-334-6656
Mailing Address - Fax:605-333-4875
Practice Address - Street 1:1727 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3245
Practice Address - Country:US
Practice Address - Phone:605-334-6656
Practice Address - Fax:605-333-4875
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1019111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994584OtherBLUE CROSS
SD7601810Medicaid
SD33947OtherSIOUX VALLEY HEALTH PLAN
SD7447594OtherAETNA
SDC1019OtherDAKOTACARE
SD243137OtherMIDLANDS CHOICE
SD9483OtherAVERA HEALTH PLANS
SDU98680Medicare UPIN
SD243137OtherMIDLANDS CHOICE