Individual
DR. JERAD ROBERT BLUDORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
505 MAIN AVE, LAKE NORDEN, SD 57248-0252
(605) 785-3900
(605) 785-3908
Mailing address
505 MAIN AVE, PO BOX 252, LAKE NORDEN, SD 57248-0252
(605) 785-3900
(605) 785-3908
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1025
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4995423
BCBS
—
05
—
7601960
—
SD
Enumeration date
07/14/2005
Last updated
11/17/2011
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