Provider Demographics
NPI:1659153617
Name:BAKKEN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BAKKEN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN BAKKEN
Authorized Official - Last Name:PASCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-672-8100
Mailing Address - Street 1:511 10 1/2 ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4024
Mailing Address - Country:US
Mailing Address - Phone:701-672-8100
Mailing Address - Fax:701-672-8101
Practice Address - Street 1:511 10 1/2 ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4024
Practice Address - Country:US
Practice Address - Phone:701-672-8100
Practice Address - Fax:701-672-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty