Organization
CLINIC FHSC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN JENKINS DC (OWNER)
(701) 492-0696
Entity
Organization
Contact information
Practice address
1207 PRAIRIE PKWY, WEST FARGO, ND 58078-3145
(701) 492-0696
Mailing address
1207 PRAIRIE PKWY, WEST FARGO, ND 58078-3145
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01B40TH
BLUE CROSS BLUE SHIELD MN
MN
05
—
1451977
—
ND
01
—
22991
BLUE CROSS BLUE SHIELD ND
ND
01
—
DE5709
MEDICARE RAILROAD
ND
Enumeration date
02/15/2008
Last updated
12/16/2018
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