Provider Demographics
NPI:1790915114
Name:HEALTHFIRST CHIROPRACTIC OF WATERTOWN
Entity Type:Organization
Organization Name:HEALTHFIRST CHIROPRACTIC OF WATERTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-882-3726
Mailing Address - Street 1:1024 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9120
Mailing Address - Country:US
Mailing Address - Phone:605-882-3726
Mailing Address - Fax:605-882-3727
Practice Address - Street 1:1024 29TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9120
Practice Address - Country:US
Practice Address - Phone:605-882-3726
Practice Address - Fax:605-882-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1086261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1174572309Medicaid
1174572309OtherWELLMARK BLUE CROSS AND BLUE SHIELD
1174572309OtherWELLMARK BLUE CROSS AND BLUE SHIELD
1174572309Medicare PIN