Provider Demographics
NPI:1164595955
Name:NOKKEN CHIROPRACTIC CLINIC LTD
Entity Type:Organization
Organization Name:NOKKEN CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NOKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-233-1188
Mailing Address - Street 1:1220 2ND AVE S
Mailing Address - Street 2:NOKKEN CHIROPRACTIC CLINIC LTD
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-233-1188
Mailing Address - Fax:218-287-1829
Practice Address - Street 1:1220 2ND AVE S
Practice Address - Street 2:NOKKEN CHIROPRACTIC CLINIC LTD
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-233-1188
Practice Address - Fax:218-287-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3240111N00000X
ND578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13845NOKOtherBCND
MN4C942TOOtherBCMN
MN183190000Medicaid