=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164599874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUDELSKA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 10/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 COMMERCE ST. SUITE 102
-----------------------------------------------------
City | MITCHELL
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-996-0191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 923
-----------------------------------------------------
City | MITCHELL
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57301-0923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-996-0191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC PHYSICIAN OWNER
-----------------------------------------------------
Name | DR. REBECCA ANN STUDELSKA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 605-996-0191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 981
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------