Healthcare Provider Details

I. General information

NPI: 1609551340
Provider Name (Legal Business Name): COLEMAN JOHN KOONS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W HAVENS AVE STE 3
MITCHELL SD
57301-4105
US

IV. Provider business mailing address

1415 W HAVENS AVE STE 3
MITCHELL SD
57301-4105
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 Number1465
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: