Provider Demographics
NPI:1780721829
Name:LARIMORE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:LARIMORE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:JAMESON
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-343-6496
Mailing Address - Street 1:320 BOOTH AVE.
Mailing Address - Street 2:
Mailing Address - City:LARIMORE
Mailing Address - State:ND
Mailing Address - Zip Code:58251-0729
Mailing Address - Country:US
Mailing Address - Phone:701-343-6496
Mailing Address - Fax:
Practice Address - Street 1:320 BOOTH AVE.
Practice Address - Street 2:
Practice Address - City:LARIMORE
Practice Address - State:ND
Practice Address - Zip Code:58251-0729
Practice Address - Country:US
Practice Address - Phone:701-343-6496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00272001OtherBLUE CROSS BLUE SHIELD
NDN1000272Medicare ID - Type Unspecified