Provider Demographics
NPI:1073668182
Name:MANDAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MANDAN CHIROPRACTIC CLINIC
Other - Org Name:ADVANCED SPINE AND REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:ISAACSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-663-0480
Mailing Address - Street 1:1302 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554
Mailing Address - Country:US
Mailing Address - Phone:701-663-0480
Mailing Address - Fax:701-663-9046
Practice Address - Street 1:1302 1ST ST NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554
Practice Address - Country:US
Practice Address - Phone:701-663-0480
Practice Address - Fax:701-663-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty