Provider Demographics
NPI:1104162924
Name:THOMSEN CHIROPRACTIC PC
Entity type:Organization
Organization Name:THOMSEN CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-845-2481
Mailing Address - Street 1:1530 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3648
Mailing Address - Country:US
Mailing Address - Phone:701-845-2481
Mailing Address - Fax:701-845-8747
Practice Address - Street 1:1530 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3648
Practice Address - Country:US
Practice Address - Phone:701-845-2481
Practice Address - Fax:701-845-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty