Provider Demographics
NPI:1699954545
Name:NORTHWOOD CHIROPRACTIC PC
Entity type:Organization
Organization Name:NORTHWOOD CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:THORSGARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-587-6300
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:12 N PARK ST
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0442
Mailing Address - Country:US
Mailing Address - Phone:701-587-6300
Mailing Address - Fax:
Practice Address - Street 1:12 N PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-0442
Practice Address - Country:US
Practice Address - Phone:701-587-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13215Medicaid
ND13215Medicaid
V01894Medicare UPIN