Provider Demographics
NPI:1164431789
Name:BEKKUM, PAUL M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BEKKUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 43RD ST S STE F
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2099
Mailing Address - Country:US
Mailing Address - Phone:701-356-0016
Mailing Address - Fax:701-892-7064
Practice Address - Street 1:1102 43RD ST S STE F
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2099
Practice Address - Country:US
Practice Address - Phone:701-356-0016
Practice Address - Fax:701-892-7064
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27849OtherBLUECROSS BLUESHIELD OF NORTH DAKOTA
ND14168Medicaid
WI350048980OtherRAILROAD MEDICARE
WI38872600Medicaid
ND1023286614OtherTHE CLINIC NPI
MN404627700Medicaid
ND14168Medicaid