Provider Demographics
NPI:1265804215
Name:TRUE NORTH CHIROPRACTIC, PC
Entity type:Organization
Organization Name:TRUE NORTH CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JADIAN
Authorized Official - Middle Name:STARLA
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-871-8483
Mailing Address - Street 1:909 11TH ST E
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1855
Mailing Address - Country:US
Mailing Address - Phone:701-228-2275
Mailing Address - Fax:701-228-3080
Practice Address - Street 1:909 11TH ST E
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1855
Practice Address - Country:US
Practice Address - Phone:701-228-2275
Practice Address - Fax:701-228-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND949111N00000X
ND947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty