Provider Demographics
NPI:1679846745
Name:HALVORSON, SHAWN TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:TIMOTHY
Last Name:HALVORSON
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 1:4610 AMBER VALLEY PKWY S
Mailing Address - Street 2:STE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8621
Mailing Address - Country:US
Mailing Address - Phone:701-364-9355
Mailing Address - Fax:701-364-4032
Practice Address - Street 1:5357 27TH ST S
Practice Address - Street 2:APT 103
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7155
Practice Address - Country:US
Practice Address - Phone:701-739-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor