Provider Demographics
NPI:1952582983
Name:MIDWEST CHIROPRACTIC PA
Entity Type:Organization
Organization Name:MIDWEST CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-772-3505
Mailing Address - Street 1:2600 DEMERS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4100
Mailing Address - Country:US
Mailing Address - Phone:701-772-3505
Mailing Address - Fax:701-772-3061
Practice Address - Street 1:2600 DEMERS AVE STE 110
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4100
Practice Address - Country:US
Practice Address - Phone:701-772-3505
Practice Address - Fax:701-772-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2C980GAOtherBCBS MN
ND11459GAOtherBCBS ND
ND11459GAOtherBCBS ND
MNCO4246Medicare PIN
MN350002702Medicare UPIN