Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 980 | SD |
N | 111NS0005X | Chiropractic Sports Physician | 980 | SD |
NPI | 1376529388 |
---|---|
Provider Name | Dr. Jason D Henry |
First Address | Sioux Falls, SD 57103-3245 |
Second Address | Sioux Falls, SD 57103-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 06/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1594359 | AMERICA'S PPO (01) | SD |
20632 | SIOUX VALLEY HEALTH PLAN (01) | SD |
4994635 | BLUE CROSS (01) | SD |
6437 | AVERA HEALTH PLANS (01) | SD |
7594362 | AETNA (01) | SD |
C980 | DAKOTACARE (01) | SD |
U89419 | (02) | SD |