Provider Demographics
NPI:1396893038
Name:JORGENSON, BRETT (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3378
Mailing Address - Country:US
Mailing Address - Phone:701-282-6110
Mailing Address - Fax:701-282-6113
Practice Address - Street 1:1201 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3378
Practice Address - Country:US
Practice Address - Phone:701-282-6110
Practice Address - Fax:701-282-6113
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN382S2JOOtherBLUE SHIELD PIN
ND18691Medicaid
ND022317OtherBLUE SHIELD PIN
ND022317OtherBLUE SHIELD PIN
ND22317Medicare ID - Type Unspecified