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General NPI Number Information
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NPI Number | 1518653690
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Entity Type | Organization
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Legal Business Name | MODERN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 1050 31ST AVE SW STE D
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City | MINOT
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State | ND
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Zip | 58701-2005
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Country | US
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Telephone | 701-837-4900
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Fax | 701-837-4901
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Provider Business Mailing Address
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Address Line | 1050 31ST AVE SW STE D
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City | MINOT
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State | ND
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Zip | 58701-2005
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Country | US
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Telephone | 701-837-4900
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Fax | 701-837-4901
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Authorized Official
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Title or Position | OWNER
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Name | SHAD FROSETH
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Credential | DC
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Telephone | 701-837-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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