Organization
SYVRUD CHIROPRACTIC CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY M LARSON (OFFICE MANAGER)
(701) 237-5150
Entity
Organization
Contact information
Practice address
825 25TH ST S, FARGO, ND 58103-8724
(701) 237-5150
(701) 237-5150
Mailing address
825 25TH ST S STE C, FARGO, ND 58103-8724
(701) 237-5150
(701) 237-5150
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
497
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16342
—
ND
01
—
26293
BLUE CROSS BLUE SHIELD OF ND
ND
01
—
340115
OPTUM HEALTH
—
01
—
350053619
RR MEDICARE
—
01
—
63140SY
BLUE CROSS BLUE SHIELD OF MN
MN
05
—
653528300
—
MN
Enumeration date
06/04/2010
Last updated
04/14/2016
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