Provider Demographics
NPI:1750578993
Name:DYNAMIC HEALTH SOULTIONS, INC
Entity type:Organization
Organization Name:DYNAMIC HEALTH SOULTIONS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-380-6812
Mailing Address - Street 1:1839 E CAPITOL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5617
Mailing Address - Country:US
Mailing Address - Phone:701-369-3938
Mailing Address - Fax:
Practice Address - Street 1:1839 E CAPITOL AVE STE B
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-369-3938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4016111N00000X
ND887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462788Medicaid
ND887OtherSTATE LICENSE