Provider Demographics
NPI:1548399264
Name:BRUCE L. REDINGTON, D.C.
Entity Type:Organization
Organization Name:BRUCE L. REDINGTON, D.C.
Other - Org Name:WEST FARGO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-282-2919
Mailing Address - Street 1:205 SHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1752
Mailing Address - Country:US
Mailing Address - Phone:701-282-2919
Mailing Address - Fax:701-282-2932
Practice Address - Street 1:205 SHEYENNE ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1752
Practice Address - Country:US
Practice Address - Phone:701-282-2919
Practice Address - Fax:701-282-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND318111N00000X
ND614111N00000X
ND518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05357001OtherBC
ND12879Medicaid
ND=========000OtherWSI
ND=========000OtherWSI