Provider Demographics
NPI:1417785338
Name:PROCHNOW, BRADEN REED (ATC, LAT)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:REED
Last Name:PROCHNOW
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4360
Mailing Address - Country:US
Mailing Address - Phone:701-403-5700
Mailing Address - Fax:
Practice Address - Street 1:7500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-9652
Practice Address - Country:US
Practice Address - Phone:701-355-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND965-232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer