Provider Demographics
NPI:1093014235
Name:SUMMIT CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROERS
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:701-356-7660
Mailing Address - Street 1:300 45TH ST S
Mailing Address - Street 2:315
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1189
Mailing Address - Country:US
Mailing Address - Phone:701-356-7660
Mailing Address - Fax:
Practice Address - Street 1:300 45TH ST S
Practice Address - Street 2:315
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1189
Practice Address - Country:US
Practice Address - Phone:701-356-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty