Healthcare Provider Details

I. General information

NPI: 1376721647
Provider Name (Legal Business Name): CHIROPRACTIC CENTER FOR HEALTHY LIVING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 WEST HAVENS STREET SUITE 3
MITCHELL SD
57301-4116
US

IV. Provider business mailing address

1415 WEST HAVENS STREET SUITE 3
MITCHELL SD
57301-4116
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-1160
  • Fax: 605-996-6433
Mailing address:
  • Phone: 605-996-1160
  • Fax: 605-996-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1039
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1040
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number050115
License Number StateFL

VIII. Authorized Official

Name: DR. SCOTT JAMES MULLENMEISTER
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 605-996-1160