Provider Demographics
NPI:1508074162
Name:KLINDWORTH, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KLINDWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 HWY 49 NW
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523
Mailing Address - Country:US
Mailing Address - Phone:701-873-4445
Mailing Address - Fax:701-873-4199
Practice Address - Street 1:1312 HWY 49 NW
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523
Practice Address - Country:US
Practice Address - Phone:701-873-4445
Practice Address - Fax:701-873-4199
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND25577OtherBCBS NUMBER