Healthcare Provider Details

I. General information

NPI: 1477740199
Provider Name (Legal Business Name): REMILLARD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 W DIVIDE AVE
BISMARCK ND
58501-1202
US

IV. Provider business mailing address

1122 WEST DIVIDE AVE
BISMARCK ND
58501-0212
US

V. Phone/Fax

Practice location:
  • Phone: 701-258-5058
  • Fax: 701-258-1041
Mailing address:
  • Phone: 701-258-5058
  • Fax: 701-258-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY DAVID REMILLARD
Title or Position: CHIROPRACTOR
Credential:
Phone: 701-258-5058