Provider Demographics
NPI:1700908209
Name:OTTUN CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:OTTUN CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOELEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTUN COX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-259-9383
Mailing Address - Street 1:3307 GRAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6546
Mailing Address - Country:US
Mailing Address - Phone:406-259-9383
Mailing Address - Fax:406-294-2822
Practice Address - Street 1:3307 GRAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6546
Practice Address - Country:US
Practice Address - Phone:406-259-9383
Practice Address - Fax:406-294-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00067406OtherRAILROAD MEDICARE--PROVIDER PTAN
MTDQ3951OtherRAILROAD MEDICARE--GROUP PTAN
MT40153OtherBCBS OF MT
MT1720073661OtherINDIVIDUAL NPI
MT40153OtherBCBS OF MT
MTDQ3951OtherRAILROAD MEDICARE--GROUP PTAN
MT000082457Medicare ID - Type UnspecifiedCORP MEDICARE #