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General NPI Number Information
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NPI Number | 1033395280
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Entity Type | Organization
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Legal Business Name | RED RIVER FAMILY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 2534 17TH AVE S SUITE 2D
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City | GRAND FORKS
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State | ND
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Zip | 58201-5215
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Country | US
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Telephone | 701-746-8636
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Fax | 701-746-8827
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Provider Business Mailing Address
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Address Line | PO BOX 12875
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City | GRAND FORKS
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State | ND
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Zip | 58208-2875
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Country | US
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Telephone | 701-746-8636
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Fax | 701-746-8827
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BRADLEY ROBERT THOMSEN
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Credential | DC
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Telephone | 701-746-8636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 649
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License Number State | ND
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