=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255837753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS LEE HUNT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2018
-----------------------------------------------------
Last Update Date | 04/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 S MAIN ST
-----------------------------------------------------
City | MILBANK
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57252-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-432-6431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 S MAIN ST
-----------------------------------------------------
City | MILBANK
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57252-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARLANE HUNT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-432-6431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 670
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------