# BLICKENSDERFER CHIROPRACTIC P C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538386511
- **Authorized official:** DR. WILLIAM C BLICKENSDERFER D.C. (OWNER)
- **Authorized official phone:** (605) 343-1113

## Contact information

- **Practice address:** 2326 CANYON LAKE DR, STE 7, RAPID CITY, SD 57702-2913
- **Practice address phone:** (605) 343-1113
- **Practice address fax:** (605) 342-8424
- **Mailing address:** 2326 CANYON LAKE DR, STE 7, RAPID CITY, SD 57702-2913
- **Mailing address phone:** (605) 343-1113
- **Mailing address fax:** (605) 342-8424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 734 | SD | Yes |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 08/02/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0006076 | BLUE CROSS BLUE SHIELD | SD |
| 05 | — | 7603190 | — | SD |
| 01 | — | S6076 | MEDICARE B | SD |