Provider Demographics
NPI:1154865079
Name:PREMIER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY-DOMRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-838-0090
Mailing Address - Street 1:1304 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-3069
Mailing Address - Country:US
Mailing Address - Phone:701-838-0090
Mailing Address - Fax:
Practice Address - Street 1:1304 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-3069
Practice Address - Country:US
Practice Address - Phone:701-838-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1042111N00000X
ND1033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty