1649386046 NPI number — BELGRADE CHIROPRACTIC INC

Table of content: (NPI 1649386046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649386046 NPI number — BELGRADE CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELGRADE 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:
1649386046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 SPOONER RD
Provider Second Line Business Mailing Address:
SUITE #B
Provider Business Mailing Address City Name:
BELGRADE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59714-7813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-388-2225
Provider Business Mailing Address Fax Number:
406-388-0664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 SPOONER RD
Provider Second Line Business Practice Location Address:
SUITE #B
Provider Business Practice Location Address City Name:
BELGRADE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59714-7813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-388-2225
Provider Business Practice Location Address Fax Number:
406-388-0664
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYAN
Authorized Official First Name:
S
Authorized Official Middle Name:
CLINT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-388-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  848 , 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: 000042151 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0162061 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0162061 . This is a "MEDICAID EPSDT#" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 350052048 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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