Provider Demographics
NPI:1437142486
Name:DALLMAN, JOHN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:DALLMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 S COLUMBIA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4054
Mailing Address - Country:US
Mailing Address - Phone:701-775-3215
Mailing Address - Fax:
Practice Address - Street 1:1395 S COLUMBIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4054
Practice Address - Country:US
Practice Address - Phone:701-775-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND575111N00000X
MN3327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C117DAOtherBLUE CROSS BLUE SHIELD
NDDAL14199OtherBLUE CROSS BLUE SHIELD
ND11995Medicaid
MN5C117DAOtherBLUE CROSS BLUE SHIELD
ND11995Medicaid