Provider Demographics
NPI:1427080266
Name:BORGEN, AMY L (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BORGEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 27TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703
Mailing Address - Country:US
Mailing Address - Phone:701-852-0596
Mailing Address - Fax:701-852-0597
Practice Address - Street 1:309 27TH ST NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703
Practice Address - Country:US
Practice Address - Phone:701-852-0596
Practice Address - Fax:701-852-0597
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17889Medicaid
N11456Medicare ID - Type Unspecified
ND17889Medicaid