Provider Demographics
NPI:1851620876
Name:GALLATIN VALLEY CHIROPRACTIC P.L.L.C
Entity Type:Organization
Organization Name:GALLATIN VALLEY CHIROPRACTIC P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RISING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-570-5667
Mailing Address - Street 1:626 S FERGUSON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6408
Mailing Address - Country:US
Mailing Address - Phone:406-551-2177
Mailing Address - Fax:406-551-2179
Practice Address - Street 1:626 S FERGUSON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6408
Practice Address - Country:US
Practice Address - Phone:406-551-2177
Practice Address - Fax:406-551-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty