Provider Demographics
NPI:1710143540
Name:FOSS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:FOSS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-293-8736
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-1528
Mailing Address - Country:US
Mailing Address - Phone:406-293-8736
Mailing Address - Fax:406-293-8737
Practice Address - Street 1:1021 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2207
Practice Address - Country:US
Practice Address - Phone:406-293-8736
Practice Address - Fax:406-293-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00314059OtherRAIL ROAD MEDICARE
MT0000040643OtherBLUE CROSS/ BLUE SHIELD
MT0164798Medicaid
MT612577600OtherUS DEPARTMENT OF LABOR
MT000004666Medicare PIN