| Chirocenter One | |
|
2812 17th Ave S Ste C Grand Forks ND 58201-4048 | |
| (701) 775-0223 | |
| (701) 738-0655 |
| Full Name | Chirocenter One |
|---|---|
| Speciality | Clinic/Center |
| Location | 2812 17th Ave S Ste C, Grand Forks, North Dakota |
| Authorized Official Name and Position | Brian V Jongeward (OWNER DOCTOR) |
| Authorized Official Contact | 7017750223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chirocenter One 2812 17th Ave S Ste C Grand Forks ND 58201-4048 Ph: (701) 775-0223 | Chirocenter One 2812 17th Ave S Ste C Grand Forks ND 58201-4048 Ph: (701) 775-0223 |
| NPI Number | 1407909120 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 02/21/2008 |
| Medicare PECOS PAC ID | 4789653122 |
|---|---|
| Medicare Enrollment ID | O20041001000204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407909120 | NPI | - | NPPES |
| 18728 | Medicaid | ND | |
| 1407909120 | Other | ND | CLINIC NPI |
| 1376620831 | Other | ND | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 611 (North Dakota) | Primary |
| Provider Name | Brian V Jongeward |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1376620831 PECOS PAC ID: 0042211310 Enrollment ID: I20120221001058 |
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