Provider Demographics
NPI:1184953317
Name:EMPIRE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:EMPIRE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-361-1952
Mailing Address - Street 1:3701 W 49TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4218
Mailing Address - Country:US
Mailing Address - Phone:605-361-1952
Mailing Address - Fax:605-361-1952
Practice Address - Street 1:3701 W 49TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4218
Practice Address - Country:US
Practice Address - Phone:605-361-1952
Practice Address - Fax:605-361-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD701111N00000X
SD694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7602680Medicaid
SD7602660Medicaid
SDS86541Medicare PIN
SDS86542Medicare PIN