Provider Demographics
NPI:1659625283
Name:ABERDEEN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ABERDEEN CHIROPRACTIC INC
Other - Org Name:CLOONA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:DENYL
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-225-9311
Mailing Address - Street 1:310 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4126
Mailing Address - Country:US
Mailing Address - Phone:605-225-9311
Mailing Address - Fax:605-725-9314
Practice Address - Street 1:310 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4126
Practice Address - Country:US
Practice Address - Phone:605-225-9311
Practice Address - Fax:605-725-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD20110622683837Medicaid
SDS105010Medicare PIN