Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 587 | SD |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 587 | SD |
NPI | 1275715435 |
---|---|
Provider Name | Steven Headrick |
First Address | Flandreau, SD 57028-1222 |
Second Address | Flandreau, SD 57028-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2007 |
Last Update Date | 22/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2C985HE | BCBSMN (01) | MN |
46-0461355 | FED TAX ID (01) | SD |
7600752 | (05) | SD |
DP2373 | RR MEDICARE GROUP PTAN (01) | SD |
P00740093 | RR MEDICARE PTAN (01) | SD |