Provider Demographics
NPI:1447460035
Name:KONSTANT CHIROPRACTIC CLINIC, PC
Entity type:Organization
Organization Name:KONSTANT CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KONSTANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-882-1131
Mailing Address - Street 1:1308 19TH STREET NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201
Mailing Address - Country:US
Mailing Address - Phone:605-882-1131
Mailing Address - Fax:605-882-9602
Practice Address - Street 1:1308 19TH STREET NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201
Practice Address - Country:US
Practice Address - Phone:605-882-1131
Practice Address - Fax:605-882-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDC725OtherDAKOTACARE
SD22163OtherSANFORD HEALTH
SD0008353OtherBLUE CROSS BLUE SHIELD
SD7603070Medicaid
SDDG6156OtherPALMETTO GBA
SDT89018Medicare UPIN
SDDG6156OtherPALMETTO GBA