1407999022 NPI number — DR. JODI KAE SANDNESS-RIEGER DC

Table of content: DR. JODI KAE SANDNESS-RIEGER DC (NPI 1407999022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407999022 NPI number — DR. JODI KAE SANDNESS-RIEGER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDNESS-RIEGER
Provider First Name:
JODI
Provider Middle Name:
KAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1407999022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LISBON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58054-0722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-683-5337
Provider Business Mailing Address Fax Number:
701-683-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 - 11TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LISBON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-683-5337
Provider Business Practice Location Address Fax Number:
701-683-0096
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  553 , 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)

  • Identifier: 12688 . This is a "BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com