Provider Demographics
NPI:1760659403
Name:KIEFER CHIROPRACTIC CLINIC, P.L.L.C.
Entity Type:Organization
Organization Name:KIEFER CHIROPRACTIC CLINIC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/SINGLE MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-886-4951
Mailing Address - Street 1:808 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4717
Mailing Address - Country:US
Mailing Address - Phone:605-886-4951
Mailing Address - Fax:
Practice Address - Street 1:808 2ND ST SW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4717
Practice Address - Country:US
Practice Address - Phone:605-886-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD22150OtherSIOUX VALLEY HEALTH INS.
SD3396OtherAVERA HEALTH INSURANCE
SD0080605OtherBLUE CROSS/BLUE SHIELD
SD241881OtherMIDLANDS CHOICE INSURANCE
SDT66457Medicare UPIN
SD3396OtherAVERA HEALTH INSURANCE