Provider Demographics
NPI:1508045477
Name:TICKEL CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:TICKEL CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-429-3678
Mailing Address - Street 1:1137 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6144
Mailing Address - Country:US
Mailing Address - Phone:701-429-3678
Mailing Address - Fax:877-818-9672
Practice Address - Street 1:606 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3202
Practice Address - Country:US
Practice Address - Phone:701-429-3678
Practice Address - Fax:877-818-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty