Provider Demographics
NPI:1720533193
Name:SALLOUX, KIM (LAC LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:SALLOUX
Suffix:
Gender:F
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W CALLENDER ST STE 6E
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2676
Mailing Address - Country:US
Mailing Address - Phone:415-846-7288
Mailing Address - Fax:
Practice Address - Street 1:109 W CALLENDER ST STE 6E
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2676
Practice Address - Country:US
Practice Address - Phone:415-846-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT32222171100000X
MT7936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist