Organization
ORIGIN CHIROPRACTIC PHYSICIANS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOK A TOWNLEY D.C. (OWNER)
(701) 280-2599
Entity
Organization
Contact information
Practice address
1203 28TH ST S STE A, FARGO, ND 58103-8711
(701) 280-2599
(701) 280-2915
Mailing address
1203 28TH ST S STE A, FARGO, ND 58103-8711
(701) 280-2599
(701) 280-2915
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
635
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09D810R
BCBS MN
MN
01
—
17927
BCBS ND
ND
01
—
350051247
RR MEDICARE
ND
Enumeration date
09/14/2011
Last updated
05/07/2019
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