Provider Demographics
NPI:1609929033
Name:BADINGER, CORY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:JOHN
Last Name:BADINGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 32ND AVE S
Mailing Address - Street 2:SUITE G
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5985
Mailing Address - Country:US
Mailing Address - Phone:701-239-4749
Mailing Address - Fax:701-356-5198
Practice Address - Street 1:1617 32ND AVE S
Practice Address - Street 2:SUITE G
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5985
Practice Address - Country:US
Practice Address - Phone:701-239-4749
Practice Address - Fax:701-356-5198
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11271OtherBCBS
ND17302Medicaid
MN3K763BAOtherBCBS
ND17302Medicaid
ND11271OtherBCBS