Provider Demographics
NPI:1336118181
Name:CARON, DOUGLAS J (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:CARON
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 1:120 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2106
Mailing Address - Country:US
Mailing Address - Phone:605-256-2964
Mailing Address - Fax:605-636-9154
Practice Address - Street 1:120 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042
Practice Address - Country:US
Practice Address - Phone:605-256-2964
Practice Address - Fax:605-636-9154
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD667111N00000X
MN2108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD23220OtherSVHP SIOUX VALLEY HEALTH
SD7602442Medicaid
SDS86531Medicare UPIN