Provider Demographics
NPI:1629169404
Name:FAMILY FIRST CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:FAMILY FIRST CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-624-9483
Mailing Address - Street 1:102 E CHERRY ST STE 106
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-1243
Mailing Address - Country:US
Mailing Address - Phone:605-624-9483
Mailing Address - Fax:605-624-9687
Practice Address - Street 1:102 E CHERRY ST STE 106
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-1243
Practice Address - Country:US
Practice Address - Phone:605-624-9483
Practice Address - Fax:605-624-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252238-00Medicaid
SD0040462OtherWELLMARK NUMBER
NE099533Medicare PIN
SD0040462OtherWELLMARK NUMBER