MEDICARE: DR. BRIAN VANCE JONGEWARD DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	611	ND
2	111NR0400X	Rehabilitation Chiropractor	611	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376620831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN VANCE JONGEWARD DC

Provider Business Mailing Address
First Line	:	2812 17TH AVE S
Second Line	:	SUITE C
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4048
Country	:	US
Telephone Number	:	701-775-0223
Fax Number	:	701-738-0655

Provider Business Practice Location Address
First Line	:	2812 17TH AVE SOUTH
Second Line	:	SUITE C
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4048
Country	:	US
Telephone Number	:	701-775-0223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

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