Healthcare Provider Details

I. General information

NPI: 1174445746
Provider Name (Legal Business Name): JORGEN PAULSON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S STATE ST
ABERDEEN SD
57401-4527
US

IV. Provider business mailing address

933 W GLENWOOD DR
BISMARCK ND
58504-8022
US

V. Phone/Fax

Practice location:
  • Phone: 701-830-0176
  • Fax:
Mailing address:
  • Phone: 701-830-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: