Provider Demographics
NPI:1245526201
Name:ALL SEASONS FULL BODY CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:ALL SEASONS FULL BODY CHIROPRACTIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEKKUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-356-0016
Mailing Address - Street 1:1402 43RD ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7500
Mailing Address - Country:US
Mailing Address - Phone:701-356-0016
Mailing Address - Fax:701-892-7064
Practice Address - Street 1:1402 43RD ST S STE 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7500
Practice Address - Country:US
Practice Address - Phone:701-356-0016
Practice Address - Fax:701-892-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND788261QH0100X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1164431789OtherNPI