Healthcare Provider Details

I. General information

NPI: 1710489042
Provider Name (Legal Business Name): GREGORY LOWENBERG, DC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 9TH ST E STE 413
WEST FARGO ND
58078-3381
US

IV. Provider business mailing address

1420 9TH ST E STE 413
WEST FARGO ND
58078-3381
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-1263
  • Fax: 701-532-1341
Mailing address:
  • Phone: 701-532-1263
  • Fax: 701-532-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1071
License Number StateND

VIII. Authorized Official

Name: DR. GREGORY M LOWENBERG
Title or Position: OWNER
Credential: DC
Phone: 701-532-1263