Provider Demographics
NPI:1801404116
Name:ANACONDA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ANACONDA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-560-8110
Mailing Address - Street 1:610 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2469
Mailing Address - Country:US
Mailing Address - Phone:406-560-8110
Mailing Address - Fax:
Practice Address - Street 1:610 E PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2469
Practice Address - Country:US
Practice Address - Phone:406-560-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center