Provider Demographics
NPI:1083783112
Name:SUMMIT CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SUMMIT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOLARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-549-0777
Mailing Address - Street 1:1900 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6455
Mailing Address - Country:US
Mailing Address - Phone:406-549-0777
Mailing Address - Fax:406-721-9008
Practice Address - Street 1:1900 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6455
Practice Address - Country:US
Practice Address - Phone:406-549-0777
Practice Address - Fax:406-721-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1069CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0165516Medicaid
MT0165529Medicaid