Provider Demographics
NPI:1679741250
Name:PARKSIDE CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:PARKSIDE CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-343-2800
Mailing Address - Street 1:505 KANSAS CITY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3673
Mailing Address - Country:US
Mailing Address - Phone:605-343-2800
Mailing Address - Fax:605-388-8082
Practice Address - Street 1:505 KANSAS CITY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3673
Practice Address - Country:US
Practice Address - Phone:605-343-2800
Practice Address - Fax:605-388-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD350051174OtherRAILROAD MEDICARE
SD7600525Medicaid
SD350051174OtherRAILROAD MEDICARE
SD7600525Medicaid