| Clinic Fhsc Pc | |
|
1207 Prairie Pkwy West Fargo ND 58078-3145 | |
| (701) 492-0696 | |
| Not Available |
| Full Name | Clinic Fhsc Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1207 Prairie Pkwy, West Fargo, North Dakota |
| Authorized Official Name and Position | Ryan Jenkins (OWNER) |
| Authorized Official Contact | 7014920696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinic Fhsc Pc 1207 Prairie Pkwy West Fargo ND 58078-3145 Ph: () - | Clinic Fhsc Pc 1207 Prairie Pkwy West Fargo ND 58078-3145 Ph: (701) 492-0696 |
| NPI Number | 1023286614 |
|---|---|
| Provider Enumeration Date | 02/15/2008 |
| Last Update Date | 12/16/2018 |
| Medicare PECOS PAC ID | 8628088820 |
|---|---|
| Medicare Enrollment ID | O20060503000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023286614 | NPI | - | NPPES |
| 22991 | Other | ND | BLUE CROSS BLUE SHIELD ND |
| 1451977 | Medicaid | ND | |
| 01B40TH | Other | MN | BLUE CROSS BLUE SHIELD MN |
| DE5709 | Other | ND | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Chad R Zimmerman |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1225106099 PECOS PAC ID: 5294753372 Enrollment ID: I20090312000142 |
| Provider Name | Ryan Jenkins |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1255404711 PECOS PAC ID: 8426098674 Enrollment ID: I20110914000642 |
| Provider Name | Samantha R Kiecker |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1811265903 PECOS PAC ID: 4789851841 Enrollment ID: I20120113000149 |
| Provider Name | Parker Paul Mckittrick |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1639715303 PECOS PAC ID: 3072947217 Enrollment ID: I20191223000892 |
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