Healthcare Provider Details

I. General information

NPI: 1174713507
Provider Name (Legal Business Name): ALTERNATIVE BACK CARE CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W 39TH ST STE 300
SIOUX FALLS SD
57105-5700
US

IV. Provider business mailing address

229 W 39TH ST STE 300
SIOUX FALLS SD
57105-5700
US

V. Phone/Fax

Practice location:
  • Phone: 605-335-7744
  • Fax: 605-373-0343
Mailing address:
  • Phone: 605-335-7744
  • Fax: 605-373-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number810
License Number StateSD

VIII. Authorized Official

Name: DR. PAUL JOSEPH BUNKERS
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 605-335-7744