Individual
STEVEN HEADRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., DABCO
Contact information
Practice address
109 E 2ND AVE, FLANDREAU, SD 57028-1222
(605) 997-3733
Mailing address
109 E 2ND AVE, FLANDREAU, SD 57028-1222
(605) 997-3733
(605) 997-3733
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
587
SD
111NX0800X
Orthopedic Chiropractor
587
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2C985HE
BCBSMN
MN
01
—
46-0461355
FED TAX ID
SD
05
—
7600752
—
SD
01
—
DP2373
RR MEDICARE GROUP PTAN
SD
01
—
P00740093
RR MEDICARE PTAN
SD
Enumeration date
11/29/2007
Last updated
09/22/2009
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