Healthcare Provider Details

I. General information

NPI: 1598959793
Provider Name (Legal Business Name): HEALING ARTS CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 20TH ST SW SUITE B
FARGO ND
58104-5923
US

IV. Provider business mailing address

3240 15TH ST S STE C
FARGO ND
58104-6188
US

V. Phone/Fax

Practice location:
  • Phone: 701-451-9070
  • Fax: 701-364-5318
Mailing address:
  • Phone: 701-451-9070
  • Fax: 701-364-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number691
License Number StateND

VII. Legacy identifiers

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

# 1
Identifier12243
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 2
Identifier929649200
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer

VIII. Authorized Official

Name: DR. KEVIN GORDON PAAPE
Title or Position: PRESIDENT
Credential: DC
Phone: 701-451-9070