Provider Demographics
NPI:1245468891
Name:CHIRO RX, LTD.
Entity type:Organization
Organization Name:CHIRO RX, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-746-7979
Mailing Address - Street 1:2625 24TH AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6180
Mailing Address - Country:US
Mailing Address - Phone:701-746-7979
Mailing Address - Fax:701-746-9758
Practice Address - Street 1:2625 24TH AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6180
Practice Address - Country:US
Practice Address - Phone:701-746-7979
Practice Address - Fax:701-746-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty