=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760659403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIEFER CHIROPRACTIC CLINIC, P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 05/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 808 2ND ST SW
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-886-4951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 2ND ST SW
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-886-4951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/SINGLE MEMBER-MANAGER
-----------------------------------------------------
Name | DR. GARY KIEFER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 605-886-4951
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 600
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------