Provider Demographics
NPI:1962509166
Name:MIDTHUNE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:MIDTHUNE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDTHUNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-284-3030
Mailing Address - Street 1:819 30TH AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5005
Mailing Address - Country:US
Mailing Address - Phone:218-284-3030
Mailing Address - Fax:218-284-3032
Practice Address - Street 1:819 30TH AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5005
Practice Address - Country:US
Practice Address - Phone:218-284-3030
Practice Address - Fax:218-284-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO3941Medicare ID - Type Unspecified