Provider Demographics
NPI:1811160955
Name:BRINTNELL CHIROPRACTIC PC
Entity type:Organization
Organization Name:BRINTNELL CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRINTNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-838-8000
Mailing Address - Street 1:720 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6441
Mailing Address - Country:US
Mailing Address - Phone:701-838-8000
Mailing Address - Fax:701-838-8444
Practice Address - Street 1:720 20TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6441
Practice Address - Country:US
Practice Address - Phone:701-838-8000
Practice Address - Fax:701-838-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND629302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10187Medicaid
NDU6446OtherUPIN
ND10187Medicaid
ND14534Medicare PIN