Provider Demographics
NPI:1023225018
Name:DAKOTA PLAINS CHIROPRACTIC, PC
Entity type:Organization
Organization Name:DAKOTA PLAINS CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBB
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTENBORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-463-2979
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-0337
Mailing Address - Country:US
Mailing Address - Phone:701-463-2979
Mailing Address - Fax:
Practice Address - Street 1:32 N. MAIN
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-0337
Practice Address - Country:US
Practice Address - Phone:701-463-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11102Medicaid
ND20580OtherROBB GOTTENBORG'S BCBS
ND01704002OtherBCBS GROUP NUMBER
ND20580OtherROBB GOTTENBORG'S BCBS
U65130Medicare UPIN