MEDICARE: WASHBURN CHIROPRACTIC, INC

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	541	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12634	OTHER	ND	BCBS PROV. #

General Provider Information

NPI Number	:	1548475023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHBURN CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	1200 NORTH 8TH STREET
Second Line	:	PO BOX 401
City	:	NEW SALEM
State	:	ND
Zip	:	58563-0401
Country	:	US
Telephone Number	:	701-843-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 NORTH 8TH STREET
Second Line	:
City	:	NEW SALEM
State	:	ND
Zip	:	58563-0401
Country	:	US
Telephone Number	:	701-843-8888
Fax Number	:	701-462-3620

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN A. THOMPSON
Credential	:	D.C.
Telephone Number	:	701-843-8888

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	03/09/2012

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