Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111N00000X | Chiropractor | | 950 | SOUTH DAKOTA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1285220 | OTHER | SOUTH DAKOTA | ARAZ PROVIDER # |
| 2 | 2272 | OTHER | SOUTH DAKOTA | AVERA PROVIDER # |
| 3 | U83273 | MEDICARE UPIN | SOUTH DAKOTA | |
| 4 | 7281259 | OTHER | SOUTH DAKOTA | AETNA PROVIDER # |
| 5 | 21214 | OTHER | SOUTH DAKOTA | SIOUX VALLEY PROVIDER # |
| 6 | 7601122 | MEDICAID | SOUTH DAKOTA | |
| 7 | 40565 | MEDICARE PIN | SOUTH DAKOTA | |
| 8 | 9176844 | OTHER | SOUTH DAKOTA | DAKOTA CARE PROVIDER # |
| 9 | 0040565 | OTHER | SOUTH DAKOTA | BC/BS PROVIDER # |
| 10 | 651273 | OTHER | SOUTH DAKOTA | CHIRO CARE PROVIDER # |
