Provider Demographics
NPI:1821501438
Name:POKORNY CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:POKORNY CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:POKORNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-290-9888
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:701-225-1976
Practice Address - Street 1:2620 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1502
Practice Address - Country:US
Practice Address - Phone:701-290-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POKORNY CHIROPRACTIC CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463430Medicaid