Provider Demographics
NPI:1710083175
Name:POKORNY, JEFFREY D (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:POKORNY
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 1:1035 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3802
Mailing Address - Country:US
Mailing Address - Phone:701-225-9696
Mailing Address - Fax:701-225-9696
Practice Address - Street 1:1035 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3802
Practice Address - Country:US
Practice Address - Phone:701-225-9696
Practice Address - Fax:701-225-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12770Medicaid
NDU97630Medicare UPIN
NDN23674Medicare ID - Type Unspecified