Healthcare Provider Details

I. General information

NPI: 1790617264
Provider Name (Legal Business Name): PETER KOLB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W FULTON ST STE 102
RAPID CITY SD
57702-4347
US

IV. Provider business mailing address

23220 MORY RD
RAPID CITY SD
57702-6005
US

V. Phone/Fax

Practice location:
  • Phone: 605-786-2448
  • Fax:
Mailing address:
  • Phone: 605-786-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberDL316605
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: