Provider Demographics
NPI:1962483610
Name:WHOLISTIC CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WHOLISTIC CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-7777
Mailing Address - Street 1:436 S 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2520
Mailing Address - Country:US
Mailing Address - Phone:406-728-7777
Mailing Address - Fax:406-549-8352
Practice Address - Street 1:436 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2520
Practice Address - Country:US
Practice Address - Phone:406-728-7777
Practice Address - Fax:406-549-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT577CHI111N00000X
MT588CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT83703Medicare ID - Type Unspecified