Provider Demographics
NPI:1396861779
Name:CHIROPRACTIC CONNECTION
Entity Type:Organization
Organization Name:CHIROPRACTIC CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-852-5017
Mailing Address - Street 1:1050 31ST AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-2005
Mailing Address - Country:US
Mailing Address - Phone:701-852-5017
Mailing Address - Fax:701-838-4411
Practice Address - Street 1:1050 31ST AVE SW STE A
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-2005
Practice Address - Country:US
Practice Address - Phone:701-852-5017
Practice Address - Fax:701-838-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13375Medicaid
NDHOW23111OtherBLUE CROSS BLUE SHIELD
NDN711263Medicare ID - Type Unspecified
ND13375Medicaid