Provider Demographics
NPI:1548452691
Name:CASCADE CHIROPRACTIC OF SOUTH DAKOTA, PC
Entity type:Organization
Organization Name:CASCADE CHIROPRACTIC OF SOUTH DAKOTA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-745-5119
Mailing Address - Street 1:1501 HIGHWAY 18 BYP
Mailing Address - Street 2:STE. B
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-9600
Mailing Address - Country:US
Mailing Address - Phone:605-745-5119
Mailing Address - Fax:
Practice Address - Street 1:1501 HIGHWAY 18 BYP
Practice Address - Street 2:STE. B
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-9600
Practice Address - Country:US
Practice Address - Phone:605-745-5119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDZ101856OtherMEDICARE PTAN