Provider Demographics
NPI:1689823908
Name:BLACK HILLS HEALTH & WELLNESS DBA CASCADE CHIROPRACTIC
Entity Type:Organization
Organization Name:BLACK HILLS HEALTH & WELLNESS DBA CASCADE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-341-7500
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-3329
Mailing Address - Country:US
Mailing Address - Phone:605-745-5119
Mailing Address - Fax:605-745-3016
Practice Address - Street 1:711 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-2335
Practice Address - Country:US
Practice Address - Phone:605-745-5119
Practice Address - Fax:605-745-3016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK HILLS HEALTH & WELLNESS CENTER OF RAPID CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-10
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6526690001Medicare NSC