Provider Demographics
NPI:1922130152
Name:ENVIVE, P.C.
Entity Type:Organization
Organization Name:ENVIVE, P.C.
Other - Org Name:DOWNTOWN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:KRISTIAN
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-336-1188
Mailing Address - Street 1:412 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6901
Mailing Address - Country:US
Mailing Address - Phone:605-336-1188
Mailing Address - Fax:605-336-2677
Practice Address - Street 1:412 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6901
Practice Address - Country:US
Practice Address - Phone:605-336-1188
Practice Address - Fax:605-336-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS42359Medicare ID - Type UnspecifiedMEDICARE PART B - SD