Provider Demographics
NPI:1891828935
Name:DISCOVER HEALTH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DISCOVER HEALTH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LIVESAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-426-5803
Mailing Address - Street 1:1136 W DIVIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1202
Mailing Address - Country:US
Mailing Address - Phone:701-223-8237
Mailing Address - Fax:701-223-8257
Practice Address - Street 1:1136 W DIVIDE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1202
Practice Address - Country:US
Practice Address - Phone:701-223-8237
Practice Address - Fax:701-223-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN712456Medicare PIN