Provider Demographics
NPI:1508825639
Name:KUMMER, ERIC PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:KUMMER
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 1:20 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6015
Mailing Address - Country:US
Mailing Address - Phone:701-774-3635
Mailing Address - Fax:701-774-3632
Practice Address - Street 1:20 W BROADWAY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6015
Practice Address - Country:US
Practice Address - Phone:701-774-3635
Practice Address - Fax:701-774-3632
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor