Healthcare Provider Details

I. General information

NPI: 1528403466
Provider Name (Legal Business Name): DOBESH CHIROPRACTIC PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W HAVENS AVE SUITE 3
MITCHELL SD
57301-4102
US

IV. Provider business mailing address

1415 W HAVENS AVE SUITE 3
MITCHELL SD
57301-4102
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 Number1234
License Number StateSD

VIII. Authorized Official

Name: DR. KELSEY JO DOBESH
Title or Position: OWNER
Credential: DC
Phone: 605-996-1160