Provider Demographics
NPI:1609243450
Name:LITTLE MISSOURI CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LITTLE MISSOURI CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-872-6688
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:MEDORA
Mailing Address - State:ND
Mailing Address - Zip Code:58645-0343
Mailing Address - Country:US
Mailing Address - Phone:701-872-6688
Mailing Address - Fax:
Practice Address - Street 1:1462 1-94 BUSINESS LOOP EAST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601
Practice Address - Country:US
Practice Address - Phone:701-872-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty