Individual
JONATHAN W DEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4325 13TH AVE S, SUITE 5, FARGO, ND 58103-3341
(701) 212-1419
Mailing address
4325 13TH AVE S, SUITE 5, FARGO, ND 58103-3341
(701) 212-1419
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
682
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11334
—
ND
01
—
19091
BCBS OF ND PROVIDER #
ND
Enumeration date
03/21/2007
Last updated
09/10/2013
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