Healthcare Provider Details

I. General information

NPI: 1790978930
Provider Name (Legal Business Name): MONROE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W DAKOTA AVE
PIERRE SD
57501-4501
US

IV. Provider business mailing address

127 W DAKOTA AVE
PIERRE SD
57501-4501
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-0264
  • Fax: 605-945-3227
Mailing address:
  • Phone: 605-224-0264
  • Fax: 605-945-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number649
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4999237
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK BLUE CROSS
# 2
Identifier7602602
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 3
IdentifierC649
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDAKOTACARE

VIII. Authorized Official

Name: DR. JEFF MONROE
Title or Position: OWNER
Credential: DC, DACAN
Phone: 605-224-0264