Provider Demographics
NPI:1730490160
Name:PFAFF CHIROPRACTIC PROFESSIONAL LLC
Entity Type:Organization
Organization Name:PFAFF CHIROPRACTIC PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PFAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-275-5757
Mailing Address - Street 1:1911 W 57TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2710
Mailing Address - Country:US
Mailing Address - Phone:605-275-5757
Mailing Address - Fax:605-275-5758
Practice Address - Street 1:1911 W 57TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2710
Practice Address - Country:US
Practice Address - Phone:605-275-5757
Practice Address - Fax:605-275-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS104236Medicare PIN