Provider Demographics
NPI:1013067727
Name:GORSUCH FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:GORSUCH FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORSUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-341-9100
Mailing Address - Street 1:3117 W RAPID ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2340
Mailing Address - Country:US
Mailing Address - Phone:605-341-9100
Mailing Address - Fax:605-341-9200
Practice Address - Street 1:3117 W RAPID ST
Practice Address - Street 2:SUITE 5
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2340
Practice Address - Country:US
Practice Address - Phone:605-341-9100
Practice Address - Fax:605-341-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7603823Medicaid
SDU23792Medicare UPIN
SD7603823Medicaid