Provider Demographics
NPI:1104042316
Name:EAGLE LIFE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:EAGLE LIFE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-433-5433
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-0985
Mailing Address - Country:US
Mailing Address - Phone:406-433-5433
Mailing Address - Fax:406-488-8239
Practice Address - Street 1:12019 HWY 16
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270
Practice Address - Country:US
Practice Address - Phone:406-433-5433
Practice Address - Fax:406-488-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty