Provider Demographics
NPI:1265789150
Name:BREANNA BISCHOFF PC
Entity type:Organization
Organization Name:BREANNA BISCHOFF PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:BISCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-538-4114
Mailing Address - Street 1:22 WILEY AVE
Mailing Address - Street 2:PO BOX 87
Mailing Address - City:LIDGERWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58081-0087
Mailing Address - Country:US
Mailing Address - Phone:701-538-4114
Mailing Address - Fax:
Practice Address - Street 1:22 WILEY AVE.
Practice Address - Street 2:
Practice Address - City:LIDGERWOOD
Practice Address - State:ND
Practice Address - Zip Code:58053-0087
Practice Address - Country:US
Practice Address - Phone:701-538-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16756Medicaid