Provider Demographics
NPI:1699212928
Name:CREVIER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CREVIER CHIROPRACTIC LLC
Other - Org Name:CHAMPION HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CREVIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-695-8899
Mailing Address - Street 1:2410 SUNRISE RIDGE CIR
Mailing Address - Street 2:#108
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2482
Mailing Address - Country:US
Mailing Address - Phone:605-695-8899
Mailing Address - Fax:
Practice Address - Street 1:2410 SUNRISE RIDGE CIR
Practice Address - Street 2:#108
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2482
Practice Address - Country:US
Practice Address - Phone:605-695-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty