1437394483 NPI number — ABOVE & BEYOND CHIROPRACTIC

Table of content: (NPI 1437394483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437394483 NPI number — ABOVE & BEYOND CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABOVE & BEYOND CHIROPRACTIC
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:
1437394483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2506 35TH AVE S
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58104-8897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-293-1133
Provider Business Mailing Address Fax Number:
701-293-0612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2506 35TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58104-8897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-293-1133
Provider Business Practice Location Address Fax Number:
701-293-0612
Provider Enumeration Date:
12/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ST. LOUIS
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
701-293-1133

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  776 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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