Provider Demographics
NPI:1629024260
Name:PRUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:PRUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-224-9902
Mailing Address - Street 1:420 WEST SIOUX AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-9902
Mailing Address - Fax:605-224-9964
Practice Address - Street 1:420 WEST SIOUX AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-224-9902
Practice Address - Fax:605-224-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8101034Medicare PIN
SD101035Medicare PIN