Healthcare Provider Details

I. General information

NPI: 1396996815
Provider Name (Legal Business Name): DANA PAUSCH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 43RD ST S UNIT 102
FARGO ND
58103-3316
US

IV. Provider business mailing address

1665 43RD ST S UNIT 102
FARGO ND
58103-3316
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-3990
  • Fax: 701-297-4828
Mailing address:
  • Phone: 701-356-3990
  • Fax: 701-297-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number824
License Number StateND

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: