Provider Demographics
NPI:1811188907
Name:BACK ON TRACK FAMILY CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:BACK ON TRACK FAMILY CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:POPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:406-755-1001
Mailing Address - Street 1:# 5 SOUTH MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4263
Mailing Address - Country:US
Mailing Address - Phone:406-755-1001
Mailing Address - Fax:406-755-1862
Practice Address - Street 1:# 5 SOUTH MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4263
Practice Address - Country:US
Practice Address - Phone:406-755-1001
Practice Address - Fax:406-755-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT910CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42181OtherBCBS
MTU78219Medicare UPIN