Provider Demographics
NPI:1376968180
Name:MIDTOWN CHIROPRACTIC
Entity Type:Organization
Organization Name:MIDTOWN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-838-7676
Mailing Address - Street 1:212 S BROADWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3867
Mailing Address - Country:US
Mailing Address - Phone:701-838-7676
Mailing Address - Fax:701-837-7962
Practice Address - Street 1:212 S BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3867
Practice Address - Country:US
Practice Address - Phone:701-838-7676
Practice Address - Fax:701-837-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11762Medicaid