Provider Demographics
NPI:1073163176
Name:ROCK SOLID CHIROPRACTIC IN JAMESTOWN
Entity Type:Organization
Organization Name:ROCK SOLID CHIROPRACTIC IN JAMESTOWN
Other - Org Name:ROCK SOLID CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MIEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-830-0431
Mailing Address - Street 1:5135 101ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:ND
Mailing Address - Zip Code:58466-9643
Mailing Address - Country:US
Mailing Address - Phone:701-830-0431
Mailing Address - Fax:
Practice Address - Street 1:308 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:ND
Practice Address - Zip Code:58466
Practice Address - Country:US
Practice Address - Phone:701-830-0431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty