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Organization

ABC CHIROPRACTIC PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JONATHAN WALTER DEITZ D.C. (PRESIDENT)
(701) 730-7079
Entity
Organization

Contact information

Practice address
826 PARK DR S, FARGO, ND 58103-5336
(701) 730-7079
Mailing address
826 PARK DR S, FARGO, ND 58103-5336
(701) 730-7079

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
682
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
11334
ND
Enumeration date
10/16/2014
Last updated
10/16/2014
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