Provider Demographics
NPI:1841339074
Name:PRUNTY, SHANE V (DC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:V
Last Name:PRUNTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W SIOUX AVE 1
Mailing Address - Street 2:PRUNTY CHIROPRACTIC
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2481
Mailing Address - Country:US
Mailing Address - Phone:605-224-9902
Mailing Address - Fax:605-224-9964
Practice Address - Street 1:1709 N LINCOLN AVE STE 103
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-7809
Practice Address - Country:US
Practice Address - Phone:605-224-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor