Provider Demographics
NPI:1578622742
Name:GULLIKSON, STEPHEN LAVERNE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LAVERNE
Last Name:GULLIKSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MT RUSHMORE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-341-7500
Mailing Address - Fax:605-341-7903
Practice Address - Street 1:1220 MT RUSHMORE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-341-7500
Practice Address - Fax:605-341-7903
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4996466OtherBCBS
SD27031OtherSIOUX VALLEY HEALTH
SD7601582Medicaid
SD27031OtherSIOUX VALLEY HEALTH
U93698Medicare UPIN