Provider Demographics
NPI:1164431789
Name:BEKKUM, PAUL M (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BEKKUM
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 1:1402 43RD ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7500
Mailing Address - Country:US
Mailing Address - Phone:701-356-0016
Mailing Address - Fax:701-892-7064
Practice Address - Street 1:1402 43RD ST S STE 200
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7500
Practice Address - Country:US
Practice Address - Phone:701-356-0016
Practice Address - Fax:701-892-7064
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1378111NR0400X
WI2197111NS0005X
ND788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27849OtherBLUECROSS BLUESHIELD OF NORTH DAKOTA
WI38872600Medicaid
MN404627700Medicaid
WI350048980OtherRAILROAD MEDICARE
ND14168Medicaid
MN404627700Medicaid
ND14168Medicaid