Healthcare Provider Details

I. General information

NPI: 1194752717
Provider Name (Legal Business Name): HOLKUP CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S CENTRAL AVE
BEACH ND
58621-4001
US

IV. Provider business mailing address

110 S CENTRAL AVE PO BOX 908
BEACH ND
58621-4001
US

V. Phone/Fax

Practice location:
  • Phone: 701-872-7520
  • Fax: 701-872-7521
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number729
License Number StateND

VIII. Authorized Official

Name: DR. JACOB P HOLKUP
Title or Position: OWNER
Credential: DC
Phone: 701-866-4011