Healthcare Provider Details

I. General information

NPI: 1801724638
Provider Name (Legal Business Name): ASHTYN JO WILMOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 4TH AVE NW
MINOT ND
58703-3069
US

IV. Provider business mailing address

1304 4TH AVE NW
MINOT ND
58703-3069
US

V. Phone/Fax

Practice location:
  • Phone: 701-838-0090
  • Fax:
Mailing address:
  • Phone: 701-838-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1247
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: