Provider Demographics
NPI:1447404165
Name:KIDDER COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:KIDDER COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNIELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-475-5555
Mailing Address - Street 1:214 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STEELE
Mailing Address - State:ND
Mailing Address - Zip Code:58482-7317
Mailing Address - Country:US
Mailing Address - Phone:701-475-5555
Mailing Address - Fax:
Practice Address - Street 1:214 4TH ST NW
Practice Address - Street 2:
Practice Address - City:STEELE
Practice Address - State:ND
Practice Address - Zip Code:58482-7317
Practice Address - Country:US
Practice Address - Phone:701-475-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU92025Medicare UPIN
MON03B816Medicare PIN