Provider Demographics
NPI:1285025908
Name:WESTEND SPINE AND REHAB, PLLC
Entity type:Organization
Organization Name:WESTEND SPINE AND REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-261-9468
Mailing Address - Street 1:3575 45TH ST S
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8963
Mailing Address - Country:US
Mailing Address - Phone:701-639-2436
Mailing Address - Fax:701-639-2430
Practice Address - Street 1:3575 45TH ST S
Practice Address - Street 2:SUITE 112
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8963
Practice Address - Country:US
Practice Address - Phone:701-639-2436
Practice Address - Fax:701-639-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty