Provider Demographics
NPI:1750560108
Name:TOTAL HEALTH CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-234-0733
Mailing Address - Street 1:3003 32ND AVE S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6163
Mailing Address - Country:US
Mailing Address - Phone:701-234-0733
Mailing Address - Fax:701-364-0735
Practice Address - Street 1:3003 32ND AVE S
Practice Address - Street 2:SUITE 4
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6163
Practice Address - Country:US
Practice Address - Phone:701-234-0733
Practice Address - Fax:701-364-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN711317Medicare PIN
NDU68953Medicare PIN