Provider Demographics
NPI:1952594962
Name:SOUTHERN HILLS CHIROPRACTIC PC
Entity type:Organization
Organization Name:SOUTHERN HILLS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RITTERBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-745-6262
Mailing Address - Street 1:1245 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-1465
Mailing Address - Country:US
Mailing Address - Phone:605-745-6262
Mailing Address - Fax:605-745-6256
Practice Address - Street 1:1245 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1465
Practice Address - Country:US
Practice Address - Phone:605-745-6262
Practice Address - Fax:605-745-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD350056029OtherRAILROAD MEDICARE
SD7601570Medicaid
SD350056029OtherRAILROAD MEDICARE