Provider Demographics
NPI:1518041821
Name:FAMILY CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SYVRUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-878-4070
Mailing Address - Street 1:811 1/2 MAIN
Mailing Address - Street 2:BOX 41
Mailing Address - City:HEBRON
Mailing Address - State:ND
Mailing Address - Zip Code:58638-0041
Mailing Address - Country:US
Mailing Address - Phone:701-878-4070
Mailing Address - Fax:701-878-4071
Practice Address - Street 1:811 1/2 MAIN
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:ND
Practice Address - Zip Code:58638-0041
Practice Address - Country:US
Practice Address - Phone:701-878-4070
Practice Address - Fax:701-878-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDU47145Medicare UPIN