Provider Demographics
NPI:1154696060
Name:INGALLS, DUSTIN DARREL (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:DARREL
Last Name:INGALLS
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 1:26015 BOGGS CIR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-6336
Mailing Address - Country:US
Mailing Address - Phone:605-553-7796
Mailing Address - Fax:
Practice Address - Street 1:5109 S CLIFF AVE
Practice Address - Street 2:STE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5445
Practice Address - Country:US
Practice Address - Phone:605-528-6240
Practice Address - Fax:605-528-6246
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor