Provider Demographics
NPI:1841526688
Name:EBERTS, MARVIN MYRON (DC)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:MYRON
Last Name:EBERTS
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 1:193 24TH ST E STE 102
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6580
Mailing Address - Country:US
Mailing Address - Phone:701-225-3536
Mailing Address - Fax:701-483-3523
Practice Address - Street 1:193 24TH ST E STE 102
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6580
Practice Address - Country:US
Practice Address - Phone:701-225-3536
Practice Address - Fax:701-483-3523
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14972Medicaid