Provider Demographics
NPI:1790978930
Name:MONROE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MONROE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACAN
Authorized Official - Phone:605-224-0264
Mailing Address - Street 1:127 W DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4501
Mailing Address - Country:US
Mailing Address - Phone:605-224-0264
Mailing Address - Fax:605-945-3227
Practice Address - Street 1:127 W DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4501
Practice Address - Country:US
Practice Address - Phone:605-224-0264
Practice Address - Fax:605-945-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD649111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4999237OtherWELLMARK BLUE CROSS
SD7602602Medicaid
SDC649OtherDAKOTACARE
SDS8481Medicare PIN
SDC649OtherDAKOTACARE