Provider Demographics
NPI:1578605283
Name:ANDERSON FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ANDERSON FAMILY CHIROPRACTIC, LLC
Other - Org Name:WELLNESS MONTANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-522-5433
Mailing Address - Street 1:8332 HUFFINE LN
Mailing Address - Street 2:STE 5
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6930
Mailing Address - Country:US
Mailing Address - Phone:406-522-5433
Mailing Address - Fax:
Practice Address - Street 1:8332 HUFFINE LN
Practice Address - Street 2:STE 5
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6930
Practice Address - Country:US
Practice Address - Phone:406-522-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON FAMILY CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty