Healthcare Provider Details

I. General information

NPI: 1285642280
Provider Name (Legal Business Name): JONATHON H REDINGTON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SHEYENNE ST
WEST FARGO ND
58078-1752
US

IV. Provider business mailing address

205 SHEYENNE ST STE 3
WEST FARGO ND
58078-1752
US

V. Phone/Fax

Practice location:
  • Phone: 701-282-2919
  • Fax: 701-282-2932
Mailing address:
  • Phone: 701-282-2919
  • Fax: 701-282-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number614
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: