Healthcare Provider Details

I. General information

NPI: 1306487624
Provider Name (Legal Business Name): BERESFORD FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 16TH ST
BERESFORD SD
57004-1503
US

IV. Provider business mailing address

504 N 16TH ST
BERESFORD SD
57004-1503
US

V. Phone/Fax

Practice location:
  • Phone: 605-763-8056
  • Fax: 605-763-8056
Mailing address:
  • Phone: 605-763-8056
  • Fax: 605-763-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: KEVIN HUGGENBERGER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 605-763-8056