Provider Demographics
NPI:1710489042
Name:GREGORY LOWENBERG, DC, PC
Entity Type:Organization
Organization Name:GREGORY LOWENBERG, DC, PC
Other - Org Name:WESTSIDE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-532-1263
Mailing Address - Street 1:1420 9TH ST E STE 413
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3381
Mailing Address - Country:US
Mailing Address - Phone:701-532-1263
Mailing Address - Fax:701-532-1341
Practice Address - Street 1:1420 9TH ST E STE 413
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3381
Practice Address - Country:US
Practice Address - Phone:701-532-1263
Practice Address - Fax:701-532-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty