Provider Demographics
NPI:1922055714
Name:HEALTHSOURCE CHIROPRACTIC & PROGRESSIVE REHAB OF SIOUX FALLS PC
Entity Type:Organization
Organization Name:HEALTHSOURCE CHIROPRACTIC & PROGRESSIVE REHAB OF SIOUX FALLS PC
Other - Org Name:HEALTHSOURCE OF SIOUX FALLS SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-357-8093
Mailing Address - Street 1:5128 S CLIFF AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5475
Mailing Address - Country:US
Mailing Address - Phone:605-357-8093
Mailing Address - Fax:605-357-8102
Practice Address - Street 1:5128 S CLIFF AVE STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5475
Practice Address - Country:US
Practice Address - Phone:605-357-8093
Practice Address - Fax:605-357-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD22262OtherSVHP
SD7601740Medicaid
SD4996421OtherBLUE CROSS BLUE SHIELD
SD7601740Medicaid
SD4996421OtherBLUE CROSS BLUE SHIELD