1679801948 NPI number — NEW LEAF CHIROPRACTIC, PLLC

Table of content: (NPI 1679801948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679801948 NPI number — NEW LEAF CHIROPRACTIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LEAF CHIROPRACTIC, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679801948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 W SPRUCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-549-0119
Provider Business Mailing Address Fax Number:
406-549-0946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 W SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-549-0119
Provider Business Practice Location Address Fax Number:
406-549-0946
Provider Enumeration Date:
11/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GUIGNARD
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR, OWNER
Authorized Official Telephone Number:
406-549-0119

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1216 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366778003 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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