Provider Demographics
NPI:1831564608
Name:WHITEWOOD CREEK CHIROPRACTIC PC
Entity type:Organization
Organization Name:WHITEWOOD CREEK CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-641-9086
Mailing Address - Street 1:1001 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWOOD
Mailing Address - State:SD
Mailing Address - Zip Code:57793-3054
Mailing Address - Country:US
Mailing Address - Phone:605-717-2428
Mailing Address - Fax:605-717-2491
Practice Address - Street 1:1001 MEADE ST
Practice Address - Street 2:
Practice Address - City:WHITEWOOD
Practice Address - State:SD
Practice Address - Zip Code:57793-3054
Practice Address - Country:US
Practice Address - Phone:605-717-2428
Practice Address - Fax:605-717-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty