Provider Demographics
NPI:1992833909
Name:THE INSTITUTE FOR CHIROPRACTIC HEALTH & WELLNESS INC
Entity Type:Organization
Organization Name:THE INSTITUTE FOR CHIROPRACTIC HEALTH & WELLNESS INC
Other - Org Name:BE ACTIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR,OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAUSGRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-919-8416
Mailing Address - Street 1:4674 40TH AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4501
Mailing Address - Country:US
Mailing Address - Phone:701-364-4105
Mailing Address - Fax:
Practice Address - Street 1:4674 40TH AVE S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4501
Practice Address - Country:US
Practice Address - Phone:701-364-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1072111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02694600OtherCAPITAL BLUE CROSS
PA251782835OtherASHN
PA408566OtherHIGHMARK
PA408566OtherHIGHMARK
PA089344Medicare ID - Type UnspecifiedGROUP NUMBER
PA02694600OtherCAPITAL BLUE CROSS