1164595955 NPI number — NOKKEN CHIROPRACTIC CLINIC LTD

Table of content: (NPI 1164595955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164595955 NPI number — NOKKEN CHIROPRACTIC CLINIC LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOKKEN CHIROPRACTIC CLINIC LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164595955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 2ND AVE S
Provider Second Line Business Mailing Address:
NOKKEN CHIROPRACTIC CLINIC LTD
Provider Business Mailing Address City Name:
MOORHEAD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-233-1188
Provider Business Mailing Address Fax Number:
218-287-1829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 2ND AVE S
Provider Second Line Business Practice Location Address:
NOKKEN CHIROPRACTIC CLINIC LTD
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-233-1188
Provider Business Practice Location Address Fax Number:
218-287-1829
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOKKEN
Authorized Official First Name:
BETH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
218-233-1188

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3240 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 578 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13845NOK . This is a "BCND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 4C942TO . This is a "BCMN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 183190000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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