Provider Demographics
NPI:1144566746
Name:WEST FARGO CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:WEST FARGO CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-282-2919
Mailing Address - Street 1:205 SHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1752
Mailing Address - Country:US
Mailing Address - Phone:701-282-2919
Mailing Address - Fax:701-282-2932
Practice Address - Street 1:205 SHEYENNE ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1752
Practice Address - Country:US
Practice Address - Phone:701-282-2919
Practice Address - Fax:701-282-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty