Healthcare Provider Details

I. General information

NPI: 1568786937
Provider Name (Legal Business Name): JUSTIN BUELIGEN MS/ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 E BISMARCK EXPY
BISMARCK ND
58504-6708
US

IV. Provider business mailing address

1833 E BISMARCK EXPY
BISMARCK ND
58504-6708
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-5222
  • Fax:
Mailing address:
  • Phone: 701-323-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: