Provider Demographics
NPI:1639181464
Name:TEN BROEK, SHERI LEE (DC)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LEE
Last Name:TEN BROEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5801
Mailing Address - Country:US
Mailing Address - Phone:701-258-8388
Mailing Address - Fax:701-258-8788
Practice Address - Street 1:425 S 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5801
Practice Address - Country:US
Practice Address - Phone:701-258-8388
Practice Address - Fax:701-258-8788
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13052OtherBCBS
ND18463Medicaid
ND13052Medicare ID - Type Unspecified
ND18463Medicaid