Provider Demographics
NPI:1780877787
Name:THORSGARD, ERIK J (DC)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:J
Last Name:THORSGARD
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:PO BOX 442
Mailing Address - Street 2:12 N PARK ST
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0442
Mailing Address - Country:US
Mailing Address - Phone:701-587-6300
Mailing Address - Fax:701-587-6333
Practice Address - Street 1:12 N PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-0442
Practice Address - Country:US
Practice Address - Phone:701-587-6300
Practice Address - Fax:701-587-6333
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13215Medicaid
V01894Medicare UPIN
24753Medicare PIN