Provider Demographics
NPI:1134507551
Name:DR. VIRGINIA J. FAULKNER, P.C.
Entity Type:Organization
Organization Name:DR. VIRGINIA J. FAULKNER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-240-2789
Mailing Address - Street 1:2600 GATEWAY AVE
Mailing Address - Street 2:STE. 2
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0513
Mailing Address - Country:US
Mailing Address - Phone:701-751-1161
Mailing Address - Fax:
Practice Address - Street 1:2600 GATEWAY AVE
Practice Address - Street 2:STE. 2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0513
Practice Address - Country:US
Practice Address - Phone:701-751-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty