Healthcare Provider Details

I. General information

NPI: 1750106159
Provider Name (Legal Business Name): BACKHAUS CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 5TH AVE STE 200
BELLE FOURCHE SD
57717-2052
US

IV. Provider business mailing address

1407 5TH AVE STE 200
BELLE FOURCHE SD
57717-2052
US

V. Phone/Fax

Practice location:
  • Phone: 605-723-3434
  • Fax:
Mailing address:
  • Phone: 605-723-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COLTON A BACKHAUS
Title or Position: OWNER
Credential: DC, CSCS
Phone: 701-426-4579