Provider Demographics
NPI:1982752630
Name:JORGENSON FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:JORGENSON FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-282-6110
Mailing Address - Street 1:1201 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3378
Mailing Address - Country:US
Mailing Address - Phone:701-282-6110
Mailing Address - Fax:701-282-6113
Practice Address - Street 1:1201 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3378
Practice Address - Country:US
Practice Address - Phone:701-282-6110
Practice Address - Fax:701-282-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN382S1JOOtherBLUE SHIELD MN GROUP #
ND12046Medicaid
ND05761001OtherBLUE SHIELD GROUP #
ND12046Medicaid