Provider Demographics
NPI:1780911354
Name:PALISADES CHIROPRACTIC
Entity type:Organization
Organization Name:PALISADES CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCHLUETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-594-2011
Mailing Address - Street 1:632 N. MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARRETSON
Mailing Address - State:SD
Mailing Address - Zip Code:57030
Mailing Address - Country:US
Mailing Address - Phone:605-594-2011
Mailing Address - Fax:
Practice Address - Street 1:632 N. MAIN AVE
Practice Address - Street 2:
Practice Address - City:GARRETSON
Practice Address - State:SD
Practice Address - Zip Code:57030
Practice Address - Country:US
Practice Address - Phone:605-594-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HOPE CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5100313Medicare UPIN