Healthcare Provider Details

I. General information

NPI: 1134708126
Provider Name (Legal Business Name): JORDAN RAY FINCK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORDAN RAY FINCK DPM

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 4TH ST SE
HURON SD
57350-2590
US

IV. Provider business mailing address

172 4TH ST SE
HURON SD
57350-2590
US

V. Phone/Fax

Practice location:
  • Phone: 605-353-6200
  • Fax:
Mailing address:
  • Phone: 605-353-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number258
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPENDING
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: