Provider Demographics
NPI:1578394045
Name:DEVINE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:DEVINE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-759-7779
Mailing Address - Street 1:5629 S SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8600
Mailing Address - Country:US
Mailing Address - Phone:605-759-7779
Mailing Address - Fax:
Practice Address - Street 1:5629 S SOUTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8600
Practice Address - Country:US
Practice Address - Phone:605-759-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty