Basic Information
| Provider Information | |||||||||
| NPI: | 1942493531 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OUTLOOK CHIROPRACTIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 385 | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | ND | ||||||||
| PostalCode: | 584250385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017972941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MAIN ST NORTH | ||||||||
| Address2: | |||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224328 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | NICOLAI | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7017972941 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 656 | ND | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.