Healthcare Provider Details

I. General information

NPI: 1124113220
Provider Name (Legal Business Name): HEARTLAND CHIROPRACTIC AND SPORTS REHABILITATION CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 S CLEVELAND AVENUE
SIOUX FALLS SD
57103
US

IV. Provider business mailing address

1727 S CLEVELAND AVENUE
SIOUX FALLS SD
57103
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-6656
  • Fax:
Mailing address:
  • Phone: 605-334-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number980
License Number StateSD

VIII. Authorized Official

Name: JASON DUANE HENRY
Title or Position: OWNER/DIRECTOR
Credential: DC
Phone: 605-334-6656