Provider Demographics
NPI:1881668283
Name:HEALTHWAYS PLLC
Entity Type:Organization
Organization Name:HEALTHWAYS PLLC
Other - Org Name:BISMARCK CHIROPRACTIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-255-2476
Mailing Address - Street 1:1033 BASIN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6649
Mailing Address - Country:US
Mailing Address - Phone:701-223-6613
Mailing Address - Fax:
Practice Address - Street 1:1033 BASIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6649
Practice Address - Country:US
Practice Address - Phone:701-223-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND111N00000X
261Q00000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN70397Medicare PIN