| Chirosport Pc | |
|
128 E Holly Blvd, Brandon, SD 57005-1114 | |
| (605) 582-8800 | |
| Not Available |
| Full Name | Chirosport Pc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 128 E Holly Blvd, Brandon, South Dakota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861511479 | NPI | - | NPPES |
| 7601810 | Medicaid | SD | |
| 4995646 | Other | SD | BCBS PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | C1019 (South Dakota) | Primary |
| 111NS0005X | Chiropractor - Sports Physician | 1019 (South Dakota) | Secondary |
| Provider Name | Ross A Mcdaniel |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1558347443 PECOS PAC ID: 5496647109 Enrollment ID: I20040414001238 |
| Provider Name | Jason D Henry |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1376529388 PECOS PAC ID: 0244259711 Enrollment ID: I20051114000872 |
| Provider Name | Christopher N Mikkelsen |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1891011987 PECOS PAC ID: 1052449279 Enrollment ID: I20100510000363 |
| Provider Name | Chandra Rae Larson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1154752301 PECOS PAC ID: 7911137542 Enrollment ID: I20140522002083 |
| Mailing Address | Practice Location Address |
|---|---|
| Chirosport Pc 128 E Holly Blvd, Brandon, SD 57005-1114 Ph: (605) 582-8800 | Chirosport Pc 128 E Holly Blvd, Brandon, SD 57005-1114 Ph: (605) 582-8800 |
Envive Brandon Prof Llc Chiropractor Medicare: Medicare Enrolled Practice Location: 220 E Holly Blvd, Brandon, SD 57005 Phone: 605-582-3944 Fax: 605-582-3698 | |
Michael John Peterson, DC Chiropractor Medicare: Medicare Enrolled Practice Location: 125 E Holly Blvd, Brandon, SD 57005 Phone: 605-582-8800 | |
Paige Ward, Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 1302 E Rushmore Dr, Brandon, SD 57005 Phone: 605-583-6546 | |
Dr. Brian John Dozark, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 128 E Holly Blvd, Brandon, SD 57005 Phone: 605-582-8800 Fax: 605-582-8820 | |
Dr. Phillip Myles Dixon, DC Chiropractor Medicare: May Accept Medicare Assignments Practice Location: 220 E Holly Blvd, Brandon, SD 57005 Phone: 605-582-3944 Fax: 605-582-3698 | |
Dr. David Fitzgerald Ward, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 1302 E Rushmore Dr, Brandon, SD 57005 Phone: 605-582-6546 | |
Dr. Michael Cody Huisman, D.C. Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 117 E Holly Blvd, Brandon, SD 57005 Phone: 605-582-8800 Fax: 605-582-8820 |