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Organization
BLICKENSDERFER CHIROPRACTIC P C
Active
Organization
BLICKENSDERFER CHIROPRACTIC P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM C BLICKENSDERFER D.C. (OWNER)
(605) 343-1113
Entity
Organization
Contact information
Practice address
2326 CANYON LAKE DR, STE 7, RAPID CITY, SD 57702-2913
(605) 343-1113
(605) 342-8424
Mailing address
2326 CANYON LAKE DR, STE 7, RAPID CITY, SD 57702-2913
(605) 343-1113
(605) 342-8424
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
734
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006076
BLUE CROSS BLUE SHIELD
SD
05
—
7603190
—
SD
01
—
S6076
MEDICARE B
SD
Enumeration date
04/19/2007
Last updated
08/02/2007
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