Organization
ADVANCE CHIROPRACTIC CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE ANN HANSON (OFFICE MANAGER)
(701) 772-2670
Entity
Organization
Contact information
Practice address
2840 19TH AVE S, GRAND FORKS, ND 58201-5957
(701) 772-2670
(701) 772-2706
Mailing address
2840 19TH AVE S, GRAND FORKS, ND 58201-5957
(701) 772-2670
(701) 772-2706
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
516
ND
111N00000X
Chiropractor
Primary
566
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010810
BC/BS PROVIDER NUMBER
ND
01
—
013490
BC/BS PROVIDER NUMBER
ND
01
—
1003814484
NPI
ND
01
—
1003950023
GROUP NPI
ND
01
—
10679570758
NPI
ND
05
—
16663
—
ND
05
—
18198
—
ND
01
—
675-001
BC/BS CLINIC NUMBER
ND
01
—
N10810
MEDICARE ID-PIN
ND
01
—
N13490
MEDICARE ID-PIN
ND
Enumeration date
02/16/2007
Last updated
12/03/2009
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