Provider Demographics
NPI:1104927268
Name:BURUD, CHAD J (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:J
Last Name:BURUD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 HIGHWAY 75 N
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1007
Mailing Address - Country:US
Mailing Address - Phone:218-643-1668
Mailing Address - Fax:
Practice Address - Street 1:1325 HIGHWAY 75 N
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1007
Practice Address - Country:US
Practice Address - Phone:218-643-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3312111N00000X
ND586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN15894OtherND BCBS
ND18970Medicaid
ND14352OtherND BCBS
MN02B14BUOtherMN BCBS
ND14352Medicare ID - Type UnspecifiedND MEDICARE
MN15894OtherND BCBS
MNU62956Medicare UPIN