Healthcare Provider Details

I. General information

NPI: 1811035686
Provider Name (Legal Business Name): WAYNE R HUBER DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 69TH STREET SUITE 100
SIOUX FALLS SD
57108-2440
US

IV. Provider business mailing address

101 W 69TH STREET SUITE 100
SIOUX FALLS SD
57108-2440
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-8277
  • Fax: 605-271-7277
Mailing address:
  • Phone: 605-271-8277
  • Fax: 605-271-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number935
License Number StateSD

VIII. Authorized Official

Name: AMBER MARIE BARTMANN
Title or Position: OFFICE MANAGER
Credential:
Phone: 605-271-8277