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General NPI Number Information
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NPI Number | 1790915114
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Entity Type | Organization
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Legal Business Name | HEALTHFIRST CHIROPRACTIC OF WATERTOWN
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 1024 29TH ST SE
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City | WATERTOWN
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State | SD
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Zip | 57201-9120
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Country | US
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Telephone | 605-882-3726
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Fax | 605-882-3727
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Provider Business Mailing Address
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Address Line | 1024 29TH ST SE
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City | WATERTOWN
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State | SD
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Zip | 57201-9120
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Country | US
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Telephone | 605-882-3726
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Fax | 605-882-3727
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MIKE HENDRICKS
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Credential |
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Telephone | 605-882-3726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1086
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License Number State | SD
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