Provider Demographics
NPI:1346527819
Name:ACTIVE BODY CHIROPRACTIC
Entity Type:Organization
Organization Name:ACTIVE BODY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-852-1665
Mailing Address - Street 1:300 3RD ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3705
Mailing Address - Country:US
Mailing Address - Phone:701-852-1665
Mailing Address - Fax:701-852-1664
Practice Address - Street 1:300 3RD ST SW STE B
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3705
Practice Address - Country:US
Practice Address - Phone:701-852-1665
Practice Address - Fax:701-852-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty