MEDICARE: WESTSIDE CHIROPRACTIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1164	SD

General Provider Information

NPI Number	:	1316267859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	2720 W MAIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8128
Country	:	US
Telephone Number	:	605-342-4333
Fax Number	:	605-791-2246

Provider Business Practice Location Address
First Line	:	2720 W MAIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8128
Country	:	US
Telephone Number	:	605-342-4333
Fax Number	:	605-791-2246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICHOLAS J KRYSL
Credential	:	D.C.
Telephone Number	:	402-340-0351

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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Directions to “WESTSIDE CHIROPRACTIC, P.C. ” Practice Location

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