Provider Demographics
NPI:1326158908
Name:NOKKEN, BETH ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:NOKKEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:NOKKEN HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3240111N00000X
ND578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C943NOOtherBCBS
ND13845OtherBCBS
MN076723900Medicaid
MN350001711Medicare ID - Type Unspecified
MN076723900Medicaid