Healthcare Provider Details

I. General information

NPI: 1386788644
Provider Name (Legal Business Name): CARR CHIROPRACTIC CLINICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MAIN ST
REDFIELD SD
57469-1209
US

IV. Provider business mailing address

615 N MAIN ST
REDFIELD SD
57469-1209
US

V. Phone/Fax

Practice location:
  • Phone: 605-472-1405
  • Fax: 605-472-1408
Mailing address:
  • Phone: 605-472-1405
  • Fax: 605-472-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number964
License Number StateSD

VIII. Authorized Official

Name: KATHY CARR
Title or Position: OFFICE MANAGER
Credential:
Phone: 605-352-5264