Provider Demographics
NPI:1326370602
Name:VENTURE CHIROPRACTIC PA CORP
Entity Type:Organization
Organization Name:VENTURE CHIROPRACTIC PA CORP
Other - Org Name:VENTURE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER/VICEPRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOCKTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-730-3867
Mailing Address - Street 1:3252 51ST ST S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7897
Mailing Address - Country:US
Mailing Address - Phone:701-730-3867
Mailing Address - Fax:701-356-2992
Practice Address - Street 1:3252 51ST ST S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7897
Practice Address - Country:US
Practice Address - Phone:701-730-3867
Practice Address - Fax:701-356-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND841111N00000X
ND910111N00000X
MN5210111N00000X
MN5211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty