Provider Demographics
NPI:1548475023
Name:WASHBURN CHIROPRACTIC, INC
Entity type:Organization
Organization Name:WASHBURN CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-843-8888
Mailing Address - Street 1:1200 NORTH 8TH STREET
Mailing Address - Street 2:PO BOX 401
Mailing Address - City:NEW SALEM
Mailing Address - State:ND
Mailing Address - Zip Code:58563-0401
Mailing Address - Country:US
Mailing Address - Phone:701-843-8888
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:NEW SALEM
Practice Address - State:ND
Practice Address - Zip Code:58563-0401
Practice Address - Country:US
Practice Address - Phone:701-843-8888
Practice Address - Fax:701-462-3620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHBURN CHIROPACTIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12634OtherBCBS PROV. #
NDN12634Medicare ID - Type UnspecifiedPROVIDER #
ND12634OtherBCBS PROV. #