Provider Demographics
NPI:1699754101
Name:PRILL, ROGER DEAN JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DEAN
Last Name:PRILL
Suffix:JR
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 1:1501 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1017
Mailing Address - Country:US
Mailing Address - Phone:605-996-7288
Mailing Address - Fax:605-995-0293
Practice Address - Street 1:1501 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1017
Practice Address - Country:US
Practice Address - Phone:605-996-7288
Practice Address - Fax:605-995-0293
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD743111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U13741Medicare UPIN
SDS80148Medicare ID - Type Unspecified