Provider Demographics
NPI:1366412785
Name:KIEFER, GARY M (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:KIEFER
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 1:808 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4717
Mailing Address - Country:US
Mailing Address - Phone:605-886-4951
Mailing Address - Fax:605-886-6004
Practice Address - Street 1:808 2ND ST SW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4717
Practice Address - Country:US
Practice Address - Phone:605-886-4951
Practice Address - Fax:605-886-6004
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD241881OtherMIDLANDS CHOICE INSURANCE
SD3396OtherAVERA HEALTH INSURANCE
SD22150OtherSIOUX VALLEY HEALTH INS.
SD0080605OtherBLUE CROSS/BLUE SHIELD
SDT66457Medicare UPIN
SD0080605OtherBLUE CROSS/BLUE SHIELD