Provider Demographics
NPI:1275727588
Name:BLANCHARDS CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BLANCHARDS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-352-1690
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-0185
Mailing Address - Country:US
Mailing Address - Phone:701-352-1690
Mailing Address - Fax:701-352-2258
Practice Address - Street 1:631 W 12TH STREET
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237
Practice Address - Country:US
Practice Address - Phone:701-352-1690
Practice Address - Fax:701-352-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND311111N00000X
ND565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN92466BLOtherBLUE SHIELD MINNESOTA
OK00574001OtherBLUE CROSS NORTH DAKOTA
MN92466BLOtherBLUE SHIELD MINNESOTA