Healthcare Provider Details

I. General information

NPI: 1194095331
Provider Name (Legal Business Name): R&R CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4903 PUMICE LOOP
BISMARCK ND
58503
US

IV. Provider business mailing address

4903 PUMICE LOOP
BISMARCK ND
58503-6158
US

V. Phone/Fax

Practice location:
  • Phone: 701-720-8903
  • Fax:
Mailing address:
  • Phone: 701-720-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number849
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number849
License Number StateND

VIII. Authorized Official

Name: DANIEL ERNEST ANDERSON
Title or Position: OWNER
Credential: DC
Phone: 701-720-8903