Provider Demographics
NPI:1649374794
Name:RONAN CHIROPRACTIC INC
Entity type:Organization
Organization Name:RONAN CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:WICKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-676-0170
Mailing Address - Street 1:206 MAIN ST SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864
Mailing Address - Country:US
Mailing Address - Phone:406-676-0170
Mailing Address - Fax:406-676-0160
Practice Address - Street 1:206 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864
Practice Address - Country:US
Practice Address - Phone:406-676-0170
Practice Address - Fax:406-676-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00067474OtherRR MEDICARE
DA6765OtherRR MEDICARE GROUP
MT0165126Medicaid
MT40743OtherBCBS
MT0165126Medicaid