Provider Demographics
NPI:1598737173
Name:MITCHELL CHIROPRACTIC & ACUPUNCTURE CENTER, P.C.
Entity Type:Organization
Organization Name:MITCHELL CHIROPRACTIC & ACUPUNCTURE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-996-1078
Mailing Address - Street 1:501 W HAVENS ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4334
Mailing Address - Country:US
Mailing Address - Phone:605-996-1078
Mailing Address - Fax:605-996-3703
Practice Address - Street 1:501 W HAVENS ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4334
Practice Address - Country:US
Practice Address - Phone:605-996-1078
Practice Address - Fax:605-996-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0041206OtherBLUE CROSS
S41206OtherMEDICARE