Provider Demographics
NPI:1952448573
Name:BJORLIE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:BJORLIE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:BJORLIE CHIROPRACTIC CLINIC, P. C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BJORLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-235-8050
Mailing Address - Street 1:1383 21ST AVE N SUITE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-235-8050
Mailing Address - Fax:701-298-3738
Practice Address - Street 1:1383 21ST AVE N SUITE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-235-8050
Practice Address - Fax:701-298-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00537001OtherBS OF ND
ND12554Medicaid
MN62849BJOtherBS OF MN
ND00537001OtherBS OF ND
ND12554Medicaid