Provider Demographics
NPI:1902158264
Name:ASPIRE HEALTH CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:ASPIRE HEALTH CHIROPRACTIC, PLLC
Other - Org Name:HEALTHSOURCE OF DICKINSON, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:EBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-225-3536
Mailing Address - Street 1:383 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3017
Mailing Address - Country:US
Mailing Address - Phone:701-225-3536
Mailing Address - Fax:701-483-3523
Practice Address - Street 1:383 15TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3017
Practice Address - Country:US
Practice Address - Phone:701-225-3536
Practice Address - Fax:701-483-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND851111N00000X
ND555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty