Provider Demographics
NPI:1528294022
Name:CHIROPRACTIC REHABILITATION CENTER, PLLC
Entity type:Organization
Organization Name:CHIROPRACTIC REHABILITATION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAROLDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-364-3760
Mailing Address - Street 1:2280 45TH ST S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8781
Mailing Address - Country:US
Mailing Address - Phone:701-364-3760
Mailing Address - Fax:701-364-3761
Practice Address - Street 1:2280 45TH ST S
Practice Address - Street 2:SUITE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8781
Practice Address - Country:US
Practice Address - Phone:701-364-3760
Practice Address - Fax:701-364-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty