Healthcare Provider Details

I. General information

NPI: 1982318689
Provider Name (Legal Business Name): JESSE LEE BABCOCK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 6TH AVE SE
ABERDEEN SD
57401-4362
US

IV. Provider business mailing address

919 WILLOW DR
ABERDEEN SD
57401-1277
US

V. Phone/Fax

Practice location:
  • Phone: 605-229-1212
  • Fax:
Mailing address:
  • Phone: 605-252-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1454
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1454
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: