Presticor, Inc.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1437103959 Issued in ND

Legal business name

PRESTICOR, INC.

Doing business as

Welcyon, Fitness After 50

Practice address

2603 Kirsten LN S Ste 104
Fargo, ND 58104-5204

Phone

(701) 478-2020

NPI assigned

Aug 23, 2017

Organization subpart

No

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

Authorized official

Name

Troy Teigen

Title

Ceo/President

Phone

(701) 238-0855

Specialties & licenses 1

Addresses

Other names 1

• Welcyon, Fitness After 50 Doing business as

Locations

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

{
    "created_epoch": "1503446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511913600000",
    "number": "1487171245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 KIRSTEN LN S STE 104",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045204",
            "telephone_number": "701-478-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 KIRSTEN LN S STE 104",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045204",
            "telephone_number": "701-478-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTICOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-23",
        "last_updated": "2017-11-29",
        "status": "A",
        "authorized_official_last_name": "TEIGEN",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "701-238-0855"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "ND",
            "license": "1437103959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Welcyon, Fitness After 50",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Registered Dietitian in Fargo, ND
• Providers in Fargo, ND by specialty
• Registered Dietitian in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.