Provider Demographics
NPI:1083813992
Name:CHIROPRACTIC CARE CENTER PC
Entity type:Organization
Organization Name:CHIROPRACTIC CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-222-2252
Mailing Address - Street 1:1921 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1973
Mailing Address - Country:US
Mailing Address - Phone:701-222-2252
Mailing Address - Fax:701-222-3645
Practice Address - Street 1:1921 N 13TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1973
Practice Address - Country:US
Practice Address - Phone:701-222-2252
Practice Address - Fax:701-222-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N71148Medicare PIN