Provider Demographics
NPI:1154356483
Name:DAGEL, LANCE THOMAS (DC)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:THOMAS
Last Name:DAGEL
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 1:15 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-3612
Mailing Address - Country:US
Mailing Address - Phone:605-753-7780
Mailing Address - Fax:605-753-7881
Practice Address - Street 1:15 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3612
Practice Address - Country:US
Practice Address - Phone:605-753-7780
Practice Address - Fax:605-753-7881
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995017OtherBLUE CROSS BLUE SHIELD
SD115673OtherHEALTH PARTNERS
SD7602100Medicaid
SD14143OtherAVERA
SD41352OtherSIOUX VALLEY
SD248014OtherMIDLAND'S CHOICE
SD100430Medicare PIN