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Organization
CHIROSPORT PC
Active
Organization
CHIROSPORT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAIGE M HONNER (CLINIC MANAGER)
(605) 201-9191
Entity
Organization
Contact information
Practice address
128 E HOLLY BLVD, BRANDON, SD 57005-1114
(605) 582-8800
Mailing address
128 E HOLLY BLVD, BRANDON, SD 57005-1114
(605) 582-8800
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
C1019
SD
111NS0005X
Sports Physician Chiropractor
1019
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4995646
BCBS PROVIDER NUMBER
SD
05
—
7601810
—
SD
Enumeration date
03/28/2007
Last updated
09/05/2012
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