Healthcare Provider Details

I. General information

NPI: 1245526201
Provider Name (Legal Business Name): ALL SEASONS FULL BODY CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 43RD ST S STE 200
FARGO ND
58103-7500
US

IV. Provider business mailing address

1402 43RD ST S STE 200
FARGO ND
58103-7500
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-0016
  • Fax: 701-892-7064
Mailing address:
  • Phone: 701-356-0016
  • Fax: 701-892-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number788
License Number StateND

VIII. Authorized Official

Name: DR. PAUL M BEKKUM
Title or Position: FOUNDER AND PRESIDENT
Credential: DC
Phone: 701-356-0016