Provider Demographics
NPI:1659389906
Name:TOTAL HEALTH CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PUCHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-752-7289
Mailing Address - Street 1:690 N MERIDIAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3586
Mailing Address - Country:US
Mailing Address - Phone:406-752-7289
Mailing Address - Fax:406-752-8679
Practice Address - Street 1:690 N MERIDIAN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3586
Practice Address - Country:US
Practice Address - Phone:406-752-7289
Practice Address - Fax:406-752-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT841CHI261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000160582Medicaid
MT04-01483-3OtherMONTANA STATE FUND
MTU66966Medicare UPIN