Healthcare Provider Details

I. General information

NPI: 1922023944
Provider Name (Legal Business Name): JUSTIN DELZER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BROADWAY
CENTERVILLE SD
57014-0271
US

IV. Provider business mailing address

PO BOX 271
CENTERVILLE SD
57014-0271
US

V. Phone/Fax

Practice location:
  • Phone: 605-563-3400
  • Fax: 605-563-3401
Mailing address:
  • Phone: 605-563-3400
  • Fax: 605-563-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1036
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: