Provider Demographics
NPI:1477817344
Name:STONE GATE CHIROPRACTIC
Entity Type:Organization
Organization Name:STONE GATE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DURR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-425-2421
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:MT
Mailing Address - Zip Code:59030-0668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 SCOTT ST UNIT 1
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:MT
Practice Address - Zip Code:59030-7769
Practice Address - Country:US
Practice Address - Phone:406-425-2421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty