Provider Demographics
NPI:1891072823
Name:CEYNAR CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CEYNAR CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:CEYNAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-572-8796
Mailing Address - Street 1:2315 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3411
Mailing Address - Country:US
Mailing Address - Phone:701-572-8796
Mailing Address - Fax:701-774-0555
Practice Address - Street 1:2315 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3411
Practice Address - Country:US
Practice Address - Phone:701-572-8796
Practice Address - Fax:701-774-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND431111N00000X
ND884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty