Healthcare Provider Details

I. General information

NPI: 1174586887
Provider Name (Legal Business Name): KLEINJAN CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MAIN AVE S
BROOKINGS SD
57006-3839
US

IV. Provider business mailing address

1204 MAIN AVE S
BROOKINGS SD
57006-3839
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-4325
  • Fax: 605-301-4141
Mailing address:
  • Phone: 605-692-4325
  • Fax: 605-692-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HOLLY J SCHULTZ-NELSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-692-4325