Provider Demographics
NPI:1184055840
Name:TOBEN CHIROPRACTIC PROF LLC
Entity type:Organization
Organization Name:TOBEN CHIROPRACTIC PROF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-874-2951
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-0675
Mailing Address - Country:US
Mailing Address - Phone:605-874-2951
Mailing Address - Fax:605-874-1363
Practice Address - Street 1:409 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226-0675
Practice Address - Country:US
Practice Address - Phone:605-874-2601
Practice Address - Fax:605-874-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty