1790838126 NPI number — GREAT FALLS CHIROPRACTIC CLINIC, P.L.L.C

Table of content: (NPI 1790838126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790838126 NPI number — GREAT FALLS CHIROPRACTIC CLINIC, P.L.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT FALLS CHIROPRACTIC CLINIC, P.L.L.C
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:
1790838126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 13TH AVE S
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59405-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-727-1660
Provider Business Mailing Address Fax Number:
406-452-9094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 13TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-727-1660
Provider Business Practice Location Address Fax Number:
406-452-9094
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOEBE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-727-1660

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  473 , 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: 0160641 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000041390 . This is a "BLUE CROSS DR. STOEBE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000041203 . This is a "BCBS DR. MATURY" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: MSF0059378 . This is a "STATE FUND DR STOEBE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: DA2180 . This is a "GROUP TRAVELERS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0160956 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350008201 . This is a "TRAVELERS DR STOEBE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: MSF1264037 . This is a "STATE FUND DR MATURY" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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