Provider Demographics
NPI:1225493414
Name:POTTS CHIROPRACTIC
Entity Type:Organization
Organization Name:POTTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-363-7600
Mailing Address - Street 1:246 MARCUS ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3179
Mailing Address - Country:US
Mailing Address - Phone:406-363-7600
Mailing Address - Fax:406-363-7960
Practice Address - Street 1:246 MARCUS ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3179
Practice Address - Country:US
Practice Address - Phone:406-363-7600
Practice Address - Fax:406-363-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0381636348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty