Provider Demographics
NPI:1518296755
Name:CHIROCARE FAMILY CENTER, PC
Entity Type:Organization
Organization Name:CHIROCARE FAMILY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-852-0596
Mailing Address - Street 1:309 27TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2834
Mailing Address - Country:US
Mailing Address - Phone:701-852-0596
Mailing Address - Fax:701-852-0597
Practice Address - Street 1:309 27TH ST NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2834
Practice Address - Country:US
Practice Address - Phone:701-852-0596
Practice Address - Fax:701-852-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDU40574Medicare UPIN
NDN11456Medicare PIN