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General NPI Number Information
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NPI Number | 1225618945
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Entity Type | Organization
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Legal Business Name | FULL POTENTIAL CHIROPRACTIC AND WELLNESS, INC.
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 118 S MAIN ST
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City | HUMBOLDT
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State | SD
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Zip | 57035-2131
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Country | US
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Telephone | 605-937-7551
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Fax | 605-679-6595
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Provider Business Mailing Address
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Address Line | PO BOX 171
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City | HUMBOLDT
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State | SD
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Zip | 57035-0171
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Country | US
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Telephone | 605-937-7551
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Fax | 605-679-6595
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAYLA MARQUARDT
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Credential | DC
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Telephone | 605-937-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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