Provider Demographics
NPI:1255697165
Name:AXIOM CHIROPRACTIC PC
Entity type:Organization
Organization Name:AXIOM CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WUBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-275-2010
Mailing Address - Street 1:2203 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6551
Mailing Address - Country:US
Mailing Address - Phone:605-275-2010
Mailing Address - Fax:605-275-2040
Practice Address - Street 1:2203 W 49TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6551
Practice Address - Country:US
Practice Address - Phone:605-275-2010
Practice Address - Fax:605-275-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty