Provider Demographics
NPI:1063754638
Name:PRAIRIE HILLS CHIROPRACTIC PC
Entity type:Organization
Organization Name:PRAIRIE HILLS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-264-7351
Mailing Address - Street 1:2125 SIMS ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6561
Mailing Address - Country:US
Mailing Address - Phone:701-264-7351
Mailing Address - Fax:701-264-7352
Practice Address - Street 1:2125 SIMS ST STE 3
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6561
Practice Address - Country:US
Practice Address - Phone:701-264-7351
Practice Address - Fax:701-264-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty