Provider Demographics
NPI:1124168398
Name:MONROE, JEFF (DC, DACAN)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:MONROE
Suffix:
Gender:M
Credentials:DC, DACAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4501
Mailing Address - Country:US
Mailing Address - Phone:605-224-0264
Mailing Address - Fax:605-945-3227
Practice Address - Street 1:127 W DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4501
Practice Address - Country:US
Practice Address - Phone:605-224-0264
Practice Address - Fax:605-945-3227
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD649111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7602602Medicaid
SD4999237OtherWELLMARK BLUE CROSS
SDC649OtherDAKOTACARE
SDC649OtherDAKOTACARE
SD7602602Medicaid