Provider Demographics
NPI:1184238859
Name:PRAIRIE ROOTS CHIROPRACTIC & FUNCTIONAL MEDICINE
Entity type:Organization
Organization Name:PRAIRIE ROOTS CHIROPRACTIC & FUNCTIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-271-5640
Mailing Address - Street 1:2333 W 57TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5054
Mailing Address - Country:US
Mailing Address - Phone:605-271-5640
Mailing Address - Fax:605-653-4415
Practice Address - Street 1:2333 W 57TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5054
Practice Address - Country:US
Practice Address - Phone:605-271-5640
Practice Address - Fax:605-653-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty