Provider Demographics
NPI:1790763720
Name:JURACEK, KIMBERLY L (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:L
Last Name:JURACEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W HAVENS ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4334
Mailing Address - Country:US
Mailing Address - Phone:605-996-1078
Mailing Address - Fax:605-996-3703
Practice Address - Street 1:501 W HAVENS ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4334
Practice Address - Country:US
Practice Address - Phone:605-996-1078
Practice Address - Fax:605-996-3703
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0041209OtherBLUE CROSS BLUE SHIELD
SD0041209OtherBLUE CROSS BLUE SHIELD
SD41208Medicare ID - Type Unspecified