Provider Demographics
NPI:1073659678
Name:BYRD, REX JAMESON (DC)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:JAMESON
Last Name:BYRD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BOOTH AVE.
Mailing Address - Street 2:PO BOX 729
Mailing Address - City:LARIMORE
Mailing Address - State:ND
Mailing Address - Zip Code:58251-0729
Mailing Address - Country:US
Mailing Address - Phone:701-343-6496
Mailing Address - Fax:
Practice Address - Street 1:320 BOOTH AVE.
Practice Address - Street 2:
Practice Address - City:LARIMORE
Practice Address - State:ND
Practice Address - Zip Code:58251-0729
Practice Address - Country:US
Practice Address - Phone:701-343-6496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13787Medicaid
ND4297OtherBLUE CROSS BLUE SHIELD
ND13787Medicaid
NDN4297Medicare ID - Type Unspecified