Provider Demographics
NPI:1649386046
Name:BELGRADE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BELGRADE CHIROPRACTIC INC
Other - Org Name:BELGRADE BACK AND NECK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:S
Authorized Official - Middle Name:CLINT
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-388-2225
Mailing Address - Street 1:227 SPOONER RD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7813
Mailing Address - Country:US
Mailing Address - Phone:406-388-2225
Mailing Address - Fax:406-388-0664
Practice Address - Street 1:227 SPOONER RD
Practice Address - Street 2:SUITE #B
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7813
Practice Address - Country:US
Practice Address - Phone:406-388-2225
Practice Address - Fax:406-388-0664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELGRADE CHIROPRACTIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000042151OtherBLUE CROSS BLUE SHIELD
MT0162061Medicaid
MT0162061OtherMEDICAID EPSDT#
MT350052048OtherRAILROAD MEDICARE
MT350052048OtherRAILROAD MEDICARE
U68825Medicare UPIN
000004427Medicare ID - Type Unspecified