Provider Demographics
NPI:1518653690
Name:MODERN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MODERN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FROSETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-837-4900
Mailing Address - Street 1:1050 31ST AVE SW STE D
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-2005
Mailing Address - Country:US
Mailing Address - Phone:701-837-4900
Mailing Address - Fax:701-837-4901
Practice Address - Street 1:1050 31ST AVE SW STE D
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-2005
Practice Address - Country:US
Practice Address - Phone:701-837-4900
Practice Address - Fax:701-837-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center