Provider Demographics
NPI:1699339499
Name:POKORNY CHIROPRACTIC CLINICS LLC
Entity type:Organization
Organization Name:POKORNY CHIROPRACTIC CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POKORNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-861-0130
Mailing Address - Street 1:623 QUINCY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8230
Mailing Address - Country:US
Mailing Address - Phone:605-791-0868
Mailing Address - Fax:
Practice Address - Street 1:623 QUINCY ST STE 101
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-791-0868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1447776380Medicaid