Provider Demographics
NPI:1982846622
Name:ASHLEY WILLOW D.C., P.C.
Entity Type:Organization
Organization Name:ASHLEY WILLOW D.C., P.C.
Other - Org Name:BACK IN BALANCE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WILLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-271-5717
Mailing Address - Street 1:4301 W 57TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2251
Mailing Address - Country:US
Mailing Address - Phone:605-271-5717
Mailing Address - Fax:605-271-5562
Practice Address - Street 1:4301 W 57TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2251
Practice Address - Country:US
Practice Address - Phone:605-271-5717
Practice Address - Fax:605-271-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty