Provider Demographics
NPI:1659687796
Name:BLANCHARD CHIROPRACTIC CLINIC LTD
Entity Type:Organization
Organization Name:BLANCHARD CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-256-2720
Mailing Address - Street 1:620 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-2622
Mailing Address - Country:US
Mailing Address - Phone:701-256-2720
Mailing Address - Fax:701-256-2720
Practice Address - Street 1:620 3RD ST
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2622
Practice Address - Country:US
Practice Address - Phone:701-256-2720
Practice Address - Fax:701-256-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13594Medicaid
ND13594Medicaid