Provider Demographics
NPI:1851692263
Name:MISSOULA FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MISSOULA FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-552-7043
Mailing Address - Street 1:1120 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7925
Mailing Address - Country:US
Mailing Address - Phone:406-552-7043
Mailing Address - Fax:
Practice Address - Street 1:1120 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7925
Practice Address - Country:US
Practice Address - Phone:406-552-7043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty