Provider Demographics
NPI:1770167983
Name:POSTLETHWAITE INTEGRATIVE MEDICINE PC
Entity type:Organization
Organization Name:POSTLETHWAITE INTEGRATIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTLETHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-731-5069
Mailing Address - Street 1:204 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 W KENT AVE STE 202
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6612
Practice Address - Country:US
Practice Address - Phone:509-731-5069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service