Provider Demographics
NPI:1730266636
Name:MCBW CHIROPRACTIC PC
Entity type:Organization
Organization Name:MCBW CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHUPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-663-3380
Mailing Address - Street 1:301 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3332
Mailing Address - Country:US
Mailing Address - Phone:701-663-3380
Mailing Address - Fax:701-663-0083
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3332
Practice Address - Country:US
Practice Address - Phone:701-663-3380
Practice Address - Fax:701-663-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDDC7224OtherRAILROAD MEDICARE
ND662001OtherBCBS GROUP ID #
NDU18619Medicare UPIN
NDU95276Medicare UPIN
ND711324Medicare ID - Type UnspecifiedND GROUP MEDICARE #
ND662001OtherBCBS GROUP ID #