Provider Demographics
NPI:1104999663
Name:DAKOTA FAMILY CHIROPRACTIC CLINIC, PC
Entity type:Organization
Organization Name:DAKOTA FAMILY CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-223-8873
Mailing Address - Street 1:3712 LOCKPORT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5535
Mailing Address - Country:US
Mailing Address - Phone:701-223-8873
Mailing Address - Fax:701-223-1014
Practice Address - Street 1:3712 LOCKPORT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5535
Practice Address - Country:US
Practice Address - Phone:701-223-8873
Practice Address - Fax:701-223-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDBLO10080OtherBLUE CROSS
NDN10080Medicare ID - Type Unspecified