Provider Demographics
NPI:1942563093
Name:TALL PINES CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:TALL PINES CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-338-1695
Mailing Address - Street 1:2801 GREAT NORTHERN LOOP
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1745
Mailing Address - Country:US
Mailing Address - Phone:847-338-1695
Mailing Address - Fax:406-549-9151
Practice Address - Street 1:2801 GREAT NORTHERN LOOP
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1745
Practice Address - Country:US
Practice Address - Phone:847-338-1695
Practice Address - Fax:406-549-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty