Provider Demographics
NPI:1114095502
Name:MANHATTAN BACK & NECK INC
Entity Type:Organization
Organization Name:MANHATTAN BACK & NECK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-284-3246
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-0855
Mailing Address - Country:US
Mailing Address - Phone:406-284-3246
Mailing Address - Fax:406-284-3245
Practice Address - Street 1:114 WEST MAIN
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741
Practice Address - Country:US
Practice Address - Phone:406-284-3246
Practice Address - Fax:406-284-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000041191OtherBLUE CROSS BLUE SHIELD
MT162554Medicaid
MT160823Medicaid
MT350030064OtherRAIL ROAD MEDICARE
MT000004285Medicare ID - Type UnspecifiedMONTANA MEDICARE
MT162554Medicaid