Provider Demographics
NPI:1275755266
Name:MCKITTRICK CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MCKITTRICK CHIROPRACTIC INC.
Other - Org Name:TRENT D MCKITTRICK DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKITTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-652-3553
Mailing Address - Street 1:2212 BROADWATER AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4779
Mailing Address - Country:US
Mailing Address - Phone:406-652-3553
Mailing Address - Fax:
Practice Address - Street 1:2212 BROADWATER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4779
Practice Address - Country:US
Practice Address - Phone:406-652-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42411OtherBCBS
MT0163839Medicaid
MT0163839Medicaid