Provider Demographics
NPI:1831372416
Name:ELLENBECKER CHIROPRACTIC, PC
Entity type:Organization
Organization Name:ELLENBECKER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ELLENBECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-838-1987
Mailing Address - Street 1:1050 31ST AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-2005
Mailing Address - Country:US
Mailing Address - Phone:701-838-1987
Mailing Address - Fax:701-838-3497
Practice Address - Street 1:1050 31ST AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-2005
Practice Address - Country:US
Practice Address - Phone:701-838-1987
Practice Address - Fax:701-838-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05586001OtherBLUE SHIELD
NDN71133Medicare UPIN