Healthcare Provider Details

I. General information

NPI: 1720355589
Provider Name (Legal Business Name): PARHAM CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W 46TH ST STE 100
SIOUX FALLS SD
57105-6507
US

IV. Provider business mailing address

2500 W 46TH ST STE 100
SIOUX FALLS SD
57105-6507
US

V. Phone/Fax

Practice location:
  • Phone: 605-335-3008
  • Fax: 605-335-3107
Mailing address:
  • Phone: 605-335-3008
  • Fax: 605-335-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number926
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number926
License Number StateSD

VIII. Authorized Official

Name: DR. TYLER RAY PARHAM
Title or Position: PRESIDENT
Credential: DC
Phone: 605-335-3008