Healthcare Provider Details

I. General information

NPI: 1164431789
Provider Name (Legal Business Name): PAUL M BEKKUM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
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 TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1378
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2197
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number788
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: