Provider Demographics
NPI:1174596340
Name:CHANEY, JOHN PATRICK (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:CHANEY
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 1:136A US HIGHWAY 14A
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57754-2054
Mailing Address - Country:US
Mailing Address - Phone:605-584-1500
Mailing Address - Fax:605-722-1188
Practice Address - Street 1:136A US HIGHWAY 14A
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:SD
Practice Address - Zip Code:57754-2054
Practice Address - Country:US
Practice Address - Phone:605-584-1500
Practice Address - Fax:605-722-1188
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4996002OtherWELLMARK
SD834OtherSD CHIROPRACTORS LICENSE
SD41292Medicare ID - Type Unspecified
SDU57494Medicare UPIN