Provider Demographics
NPI:1679801948
Name:NEW LEAF CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:NEW LEAF CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIGNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-549-0119
Mailing Address - Street 1:410 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4106
Mailing Address - Country:US
Mailing Address - Phone:406-549-0119
Mailing Address - Fax:406-549-0946
Practice Address - Street 1:410 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4106
Practice Address - Country:US
Practice Address - Phone:406-549-0119
Practice Address - Fax:406-549-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1216261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366778003OtherNPI