Provider Demographics
NPI:1831425685
Name:DALLMAN CHIROPRACTIC PC
Entity type:Organization
Organization Name:DALLMAN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-775-3215
Mailing Address - Street 1:1395 S COLUMBIA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1395 S COLUMBIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4054
Practice Address - Country:US
Practice Address - Phone:701-775-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND575261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDDAL14199OtherBLUE CROSS BLUE SHIELD
MN5C116DAOtherBLUE CROSS BLUE SHIELD
ND11995Medicaid
ND11995Medicaid
NDN14199Medicare PIN