1649374794 NPI number — RONAN CHIROPRACTIC INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649374794 NPI number — RONAN CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONAN CHIROPRACTIC INC
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:
6
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:
1649374794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 MAIN ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RONAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-676-0170
Provider Business Mailing Address Fax Number:
406-676-0160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 MAIN ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-676-0170
Provider Business Practice Location Address Fax Number:
406-676-0160
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WICKLUND
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
LUCILLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-676-0170

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1050 , 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: P00067474 . This is a "RR MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: DA6765 . This is a "RR MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0165126 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40743 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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