Provider Demographics
NPI:1891720231
Name:REDINGTON, DEAN EDWARDS (DC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:EDWARDS
Last Name:REDINGTON
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 1:1001 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-852-0158
Mailing Address - Fax:701-852-5630
Practice Address - Street 1:1001 20TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-852-0158
Practice Address - Fax:701-852-5630
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND367111N00000X
SD1003111N00000X
MN4475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10468Medicaid
22705OtherBCBS
711180OtherGROUP PROVIDER #
10810OtherCLINIC MEDICAID
10810OtherCLINIC MEDICAID
ND10468Medicaid