Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 611 | ND |
N | 111NR0400X | Rehabilitation Chiropractor | 611 | ND |
NPI | 1376620831 |
---|---|
Provider Name | Dr. Brian Vance Jongeward |
First Address | Grand Forks, ND 58201-4048 |
Second Address | Grand Forks, ND 58201-4048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18728 | (05) | ND |
U59515 | (02) |