Provider Demographics
NPI:1730467192
Name:CASCADE CHIROPRACTIC OF SOUTH DAKOTA
Entity Type:Organization
Organization Name:CASCADE CHIROPRACTIC OF SOUTH DAKOTA
Other - Org Name:CASCADE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-745-5119
Mailing Address - Street 1:1501 HIGHWAY 18 BYP STE B
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-9602
Mailing Address - Country:US
Mailing Address - Phone:605-745-5119
Mailing Address - Fax:605-745-3016
Practice Address - Street 1:1501 HIGHWAY 18 BYP STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-9602
Practice Address - Country:US
Practice Address - Phone:605-745-5119
Practice Address - Fax:605-745-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty