Healthcare Provider Details

I. General information

NPI: 1518041821
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 1/2 MAIN
HEBRON ND
58638-0041
US

IV. Provider business mailing address

811 1/2 MAIN BOX 41
HEBRON ND
58638-0041
US

V. Phone/Fax

Practice location:
  • Phone: 701-878-4070
  • Fax: 701-878-4071
Mailing address:
  • Phone: 701-878-4070
  • Fax: 701-878-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number561
License Number StateND

VIII. Authorized Official

Name: DR. DANA E SYVRUD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 701-878-4070