Provider Demographics
NPI:1780718841
Name:JORDE, DENNIS A (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:JORDE
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 1:2921 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0163
Mailing Address - Country:US
Mailing Address - Phone:701-224-9008
Mailing Address - Fax:
Practice Address - Street 1:2921 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0163
Practice Address - Country:US
Practice Address - Phone:701-224-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4393OtherBLUE CROSS BLUE SHIELD
ND16327Medicaid
ND16327Medicaid