Provider Demographics
NPI:1770350084
Name:FALLS EDGE CHIROPRACTIC
Entity type:Organization
Organization Name:FALLS EDGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JADE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-210-1770
Mailing Address - Street 1:4925 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-6950
Mailing Address - Country:US
Mailing Address - Phone:605-210-1770
Mailing Address - Fax:605-332-6616
Practice Address - Street 1:4925 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6950
Practice Address - Country:US
Practice Address - Phone:605-575-3973
Practice Address - Fax:605-332-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty