Provider Demographics
NPI:1942246020
Name:WENDELL CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:WENDELL CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-274-0777
Mailing Address - Street 1:6140 S LYNCREST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2560
Mailing Address - Country:US
Mailing Address - Phone:605-274-0777
Mailing Address - Fax:605-274-0778
Practice Address - Street 1:6140 S LYNCREST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2560
Practice Address - Country:US
Practice Address - Phone:605-274-0777
Practice Address - Fax:605-274-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS101080Medicare PIN