MEDICARE: DR. CHAD ALLEN STORCH D.O.

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	2083A0100X	Aerospace Medicine Physician	12045	SD
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	12045	SD

General Provider Information

NPI Number	:	1437206471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD ALLEN STORCH D.O.

Provider Business Mailing Address
First Line	:	353 FAIRMONT BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7375
Country	:	US
Telephone Number	:	605-755-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3495
Country	:	US
Telephone Number	:	605-755-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/06/2020

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