Provider Demographics
NPI:1023270683
Name:SOUTH POINTE CHIROPRACTIC
Entity type:Organization
Organization Name:SOUTH POINTE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-234-0028
Mailing Address - Street 1:3220 18TH ST S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3220 18TH ST S
Practice Address - Street 2:SUITE 2
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6564
Practice Address - Country:US
Practice Address - Phone:701-234-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty