Provider Demographics
NPI:1174602627
Name:VETTER, DOREEN (DC)
Entity type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:VETTER
Suffix:
Gender:F
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:PHILIP CHIROPRACTIC CLINIC
Mailing Address - Street 2:PO BOX 95
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567-0095
Mailing Address - Country:US
Mailing Address - Phone:605-859-2594
Mailing Address - Fax:605-859-3190
Practice Address - Street 1:PHILIP CHIROPRACTIC CLINIC
Practice Address - Street 2:412 WEST PINE ST.,
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567-0095
Practice Address - Country:US
Practice Address - Phone:605-859-2594
Practice Address - Fax:605-859-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5365Medicare ID - Type Unspecified