Provider Demographics
NPI:1861092181
Name:ALFRED, SAMUEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:ALFRED
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W 41ST ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6195
Mailing Address - Country:US
Mailing Address - Phone:605-271-4109
Mailing Address - Fax:
Practice Address - Street 1:2101 W 41ST ST STE 4
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6195
Practice Address - Country:US
Practice Address - Phone:605-271-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor