MEDICARE: INTEGRATED CHIROPRACTIC AND REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	1193	SD
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1144697509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED CHIROPRACTIC AND REHAB

Provider Business Mailing Address
First Line	:	4301 W. 57TH STREET SUITE 131
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108
Country	:	US
Telephone Number	:	605-368-0195
Fax Number	:	605-534-7022

Provider Business Practice Location Address
First Line	:	4301 W. 57TH STREET SUITE 131
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108
Country	:	US
Telephone Number	:	605-368-0195
Fax Number	:	605-534-7022

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. GALEN R STOLP
Credential	:	DC
Telephone Number	:	605-977-2055

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	04/16/2026

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