Healthcare Provider Details

I. General information

NPI: 1831329374
Provider Name (Legal Business Name): DR. TIM A. BENNING, CHIROPRACTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22736 S ROCHFORD RD
HILL CITY SD
57745-6006
US

IV. Provider business mailing address

22736 S ROCHFORD RD
HILL CITY SD
57745-6006
US

V. Phone/Fax

Practice location:
  • Phone: 605-584-9067
  • Fax: 605-584-9067
Mailing address:
  • Phone: 605-584-9067
  • Fax: 605-584-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number856
License Number StateSD

VIII. Authorized Official

Name: DR. TIM A BENNING
Title or Position: PRESIDENT
Credential: D.C.
Phone: 605-584-9067