Provider Demographics
NPI:1336150333
Name:ORTH, MASON J (DC)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:J
Last Name:ORTH
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 1:3175 SIENNA DR S
Mailing Address - Street 2:STE 105
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8910
Mailing Address - Country:US
Mailing Address - Phone:701-451-9098
Mailing Address - Fax:701-451-9099
Practice Address - Street 1:4141 31ST AVE. SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-451-9098
Practice Address - Fax:701-451-9099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDU82118Medicare UPIN
ND19722Medicare ID - Type Unspecified