Provider Demographics
NPI:1700053741
Name:WELLNESS DIMENSIONS PC
Entity Type:Organization
Organization Name:WELLNESS DIMENSIONS PC
Other - Org Name:HEALTHSOURCE OF BISMARCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-222-8322
Mailing Address - Street 1:1051 E INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0551
Mailing Address - Country:US
Mailing Address - Phone:701-222-8322
Mailing Address - Fax:
Practice Address - Street 1:1051 E INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0551
Practice Address - Country:US
Practice Address - Phone:701-222-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14838Medicaid
NDN713548Medicare PIN