Provider Demographics
NPI:1992051221
Name:ESSENTIAL CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-797-2385
Mailing Address - Street 1:402 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58425-7541
Mailing Address - Country:US
Mailing Address - Phone:701-797-2385
Mailing Address - Fax:
Practice Address - Street 1:402 4TH ST SW
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:ND
Practice Address - Zip Code:58425-7541
Practice Address - Country:US
Practice Address - Phone:701-797-2385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty