Origin Chiropractic Physicians, PC
Organization Active NPI Chiropractor · Fargo, ND
NPI 1184906299 · NPPES record last updated May 7, 2019
Key facts
- NPI
- 1184906299
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 635 (ND)
- Legal business name
- ORIGIN CHIROPRACTIC PHYSICIANS, PC
- Practice address
- 1203 28TH St S Ste a
Fargo, ND 58103-8711 - Phone
- (701) 280-2599
- Fax
- (701) 280-2915
- NPI assigned
- Sep 14, 2011
- Organization subpart
- No
Authorized official
- Name
- Brook A Townley, D.C.
- Title
- Owner
- Phone
- (701) 280-2599
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120511000187 | ND | Part B Supplier - Clinic/Group Practice | 7719140615 |
Receives reassigned benefits from 1 practitioner Practice locations: Fargo, ND |
National Provider Directory
Locations
1203 28th St S
#A
Fargo, ND 58103
Phone (701) 280-2599
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 635 | ND | Yes |
Addresses
Primary practice location
1203 28TH St S Ste a
Fargo, ND 58103-8711
Mailing address
1203 28TH St S Ste a
Fargo, ND 58103-8711
Phone (701) 280-2599
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09D810R | Other | MN | BCBS MN |
| 350051247 | Other | ND | RR MEDICARE |
| 17927 | Other | ND | BCBS ND |
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.