Provider Demographics
NPI:1942532742
Name:LADUKE FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:LADUKE FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LADUKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-252-9852
Mailing Address - Street 1:920 10TH ST SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5819
Mailing Address - Country:US
Mailing Address - Phone:701-252-9852
Mailing Address - Fax:701-952-9853
Practice Address - Street 1:920 10TH ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5819
Practice Address - Country:US
Practice Address - Phone:701-252-9852
Practice Address - Fax:701-952-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13686Medicaid
ND1033162276OtherNPI-INDIVIDUAL
ND13686Medicaid
ND1033162276OtherNPI-INDIVIDUAL