Provider Demographics
NPI:1407212673
Name:OAHE CHIROPRACTIC AND WELLNESS, P.C.
Entity type:Organization
Organization Name:OAHE CHIROPRACTIC AND WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-945-2225
Mailing Address - Street 1:1205 N HARRISON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2397
Mailing Address - Country:US
Mailing Address - Phone:605-945-2225
Mailing Address - Fax:605-945-1104
Practice Address - Street 1:1205 N HARRISON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2397
Practice Address - Country:US
Practice Address - Phone:605-945-2225
Practice Address - Fax:605-945-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty