MEDICARE: RED ROCK CHIROPRACTIC PROF LLC

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	111N00000X	Chiropractor	1244	SD

General Provider Information

NPI Number	:	1316378078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED ROCK CHIROPRACTIC PROF LLC

Provider Business Mailing Address
First Line	:	8009 SHERIDAN LAKE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-9041
Country	:	US
Telephone Number	:	605-864-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	8009 SHERIDAN LAKE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-9041
Country	:	US
Telephone Number	:	605-864-1780
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	AMANDA BENNETT
Credential	:	D.C.
Telephone Number	:	701-650-1958

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/06/2013

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