Provider Demographics
NPI:1245422534
Name:BASLER FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BASLER FAMILY CHIROPRACTIC PC
Other - Org Name:CARLSON CHIROPRACTIC OFFICES PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:BASLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-257-3004
Mailing Address - Street 1:410 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4809
Mailing Address - Country:US
Mailing Address - Phone:406-257-3004
Mailing Address - Fax:406-257-3086
Practice Address - Street 1:410 1ST AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4809
Practice Address - Country:US
Practice Address - Phone:406-257-3004
Practice Address - Fax:406-257-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42140OtherBLUE CROSS BLUE SHIELD
MT000083317Medicare PIN
MTT02475Medicare UPIN