Provider Demographics
NPI:1376823278
Name:ROCKPOINT CHIROPRACTIC SERVICES INC.
Entity Type:Organization
Organization Name:ROCKPOINT CHIROPRACTIC SERVICES INC.
Other - Org Name:ROCKPOINT UPPER CERVICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-396-5461
Mailing Address - Street 1:4411 BORDEAUX BLVD
Mailing Address - Street 2:A
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5341
Mailing Address - Country:US
Mailing Address - Phone:406-396-5461
Mailing Address - Fax:
Practice Address - Street 1:2419 MULLAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1856
Practice Address - Country:US
Practice Address - Phone:406-541-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty