Individual
JORDAN BACKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
215 HIGHWAY 2 SW STUITE 103, RUGBY, ND 58368
(701) 351-0775
Mailing address
215 HIGHWAY 2 SW STUITE 103, RUGBY, ND 58368
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1755
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1987654321
—
ND
Enumeration date
06/20/2014
Last updated
09/10/2018
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