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General NPI Number Information
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NPI Number | 1235729617
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Entity Type | Organization
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Legal Business Name | NORTHERN PEAK CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 600 5TH ST SE STE 2
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City | WATERTOWN
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State | SD
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Zip | 57201-4915
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Country | US
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Telephone | 605-878-0167
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Fax |
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Provider Business Mailing Address
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Address Line | 600 5TH ST SE STE 2
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City | WATERTOWN
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State | SD
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Zip | 57201-4915
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Country | US
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Telephone | 605-878-0167
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. BETHANY MCMULLEN
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Credential | DC
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Telephone | 605-878-0167
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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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