Provider Demographics
NPI:1598312365
Name:BASIN HEALTH & SPINE CENTER
Entity Type:Organization
Organization Name:BASIN HEALTH & SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THEIGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-577-2472
Mailing Address - Street 1:1319 2ND AVE W # 101
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4164
Mailing Address - Country:US
Mailing Address - Phone:701-577-2472
Mailing Address - Fax:701-609-5523
Practice Address - Street 1:1319 2ND AVE W # 101
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4164
Practice Address - Country:US
Practice Address - Phone:701-577-2472
Practice Address - Fax:701-609-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty