Provider Demographics
NPI:1790838126
Name:GREAT FALLS CHIROPRACTIC CLINIC, P.L.L.C
Entity Type:Organization
Organization Name:GREAT FALLS CHIROPRACTIC CLINIC, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:STOEBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-727-1660
Mailing Address - Street 1:400 13TH AVE S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4300
Mailing Address - Country:US
Mailing Address - Phone:406-727-1660
Mailing Address - Fax:406-452-9094
Practice Address - Street 1:400 13TH AVE S
Practice Address - Street 2:SUITE 104
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4300
Practice Address - Country:US
Practice Address - Phone:406-727-1660
Practice Address - Fax:406-452-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT473111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0160641Medicaid
MT0000041390OtherBLUE CROSS DR. STOEBE
MT0000041203OtherBCBS DR. MATURY
MTMSF0059378OtherSTATE FUND DR STOEBE
MTDA2180OtherGROUP TRAVELERS
MT0160956Medicaid
MT350008201OtherTRAVELERS DR STOEBE
MTMSF1264037OtherSTATE FUND DR MATURY
MT0160641Medicaid
MT000004670Medicare ID - Type UnspecifiedDR. MATURY MEDICARE
MT000004669Medicare ID - Type UnspecifiedDR. STOEBE MEDICARE
MTMSF0059378OtherSTATE FUND DR STOEBE
MTMSF1264037OtherSTATE FUND DR MATURY