Provider Demographics
NPI:1033395280
Name:RED RIVER FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:RED RIVER FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:THOMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-746-8636
Mailing Address - Street 1:PO BOX 12875
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58208-2875
Mailing Address - Country:US
Mailing Address - Phone:701-746-8636
Mailing Address - Fax:701-746-8827
Practice Address - Street 1:2534 17TH AVE S
Practice Address - Street 2:SUITE 2D
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5215
Practice Address - Country:US
Practice Address - Phone:701-746-8636
Practice Address - Fax:701-746-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13185Medicaid
NDN714301Medicare PIN