| Modern Chiropractic Llc | |
|
1050 31st Ave Sw Ste D Minot ND 58701-2005 | |
| (701) 837-4900 | |
| (701) 837-4901 |
| Full Name | Modern Chiropractic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1050 31st Ave Sw Ste D, Minot, North Dakota |
| Authorized Official Name and Position | Shad Froseth (OWNER) |
| Authorized Official Contact | 7018374900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Chiropractic Llc 1050 31st Ave Sw Ste D Minot ND 58701-2005 Ph: (701) 837-4900 | Modern Chiropractic Llc 1050 31st Ave Sw Ste D Minot ND 58701-2005 Ph: (701) 837-4900 |
| NPI Number | 1518653690 |
|---|---|
| Provider Enumeration Date | 04/12/2023 |
| Last Update Date | 04/12/2023 |
| Medicare PECOS PAC ID | 0941666408 |
|---|---|
| Medicare Enrollment ID | O20230525002227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518653690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Crystal L Long |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1629310628 PECOS PAC ID: 1456640713 Enrollment ID: I20160510002088 |
| Provider Name | Shad Froseth |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1235713892 PECOS PAC ID: 0941686976 Enrollment ID: I20220928003366 |
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