NPIMap

Organization Active NPI

Premier Chiropractic PC

  • Chiropractor
  • Minot, ND
National Provider Identifier
1154865079
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1033 Issued in ND
Legal business name
PREMIER CHIROPRACTIC PC
Practice address
1304 4TH Ave NW
Minot, ND 58703-3069
Phone
(701) 838-0090
NPI assigned
Dec 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Becky Perry-Domres, D.C.
Title
Doctor of Chiropractic
Phone
(701) 838-0090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 1042 ND
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 1033 ND Primary

Addresses

Primary practice location

1304 4TH Ave NW
Minot, ND 58703-3069

Mailing address

1304 4TH Ave NW
Minot, ND 58703-3069
Phone (701) 838-0090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170306001761 ND Part B Supplier - Clinic/Group Practice 9638453939 Receives reassigned benefits from 5 practitioners
Practice locations: Minot, ND

National Provider Directory

National Provider Directory

Locations

1304 4th Ave NW
Minot, ND 58703
Phone (701) 838-0090

300 3rd Ave SW
Ste F
Minot, ND 58701
Phone (701) 833-0090

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1154865079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 4TH AVE NW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587033069",
            "telephone_number": "701-838-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 4TH AVE NW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587033069",
            "telephone_number": "701-838-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-12",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "PERRY-DOMRES",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "701-838-0090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "1042",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "1033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.