Provider Demographics
NPI:1992355978
Name:CUSTER CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:CUSTER CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MECKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-673-5971
Mailing Address - Street 1:246 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-1506
Mailing Address - Country:US
Mailing Address - Phone:605-673-5971
Mailing Address - Fax:605-673-5972
Practice Address - Street 1:246 N 5TH ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1506
Practice Address - Country:US
Practice Address - Phone:605-673-5971
Practice Address - Fax:605-673-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty