Healthcare Provider Details

I. General information

NPI: 1780877787
Provider Name (Legal Business Name): ERIK J THORSGARD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N PARK ST
NORTHWOOD ND
58267-0442
US

IV. Provider business mailing address

PO BOX 442 12 N PARK ST
NORTHWOOD ND
58267-0442
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-6300
  • Fax: 701-587-6333
Mailing address:
  • Phone: 701-587-6300
  • Fax: 701-587-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number752
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: