Provider Demographics
NPI:1730631854
Name:FAHRENDORF FAMILY CHIROPRACTIC & WELLNESS, P.C.
Entity type:Organization
Organization Name:FAHRENDORF FAMILY CHIROPRACTIC & WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FAHRENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-334-8000
Mailing Address - Street 1:3909 S SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7186
Mailing Address - Country:US
Mailing Address - Phone:605-334-8000
Mailing Address - Fax:605-330-0889
Practice Address - Street 1:3909 S SOUTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7186
Practice Address - Country:US
Practice Address - Phone:605-334-8000
Practice Address - Fax:605-330-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty