Provider Demographics
NPI:1801001755
Name:KOELE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:KOELE FAMILY CHIROPRACTIC
Other - Org Name:KOELE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-498-2273
Mailing Address - Street 1:710 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-3209
Mailing Address - Country:US
Mailing Address - Phone:605-498-2273
Mailing Address - Fax:605-498-2225
Practice Address - Street 1:710 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-3209
Practice Address - Country:US
Practice Address - Phone:605-498-2273
Practice Address - Fax:605-498-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1105111N00000X
IA06944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty