Provider Demographics
NPI:1780714055
Name:OTHEIM, KEVIN CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHARLES
Last Name:OTHEIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CENTRAL AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3776
Mailing Address - Country:US
Mailing Address - Phone:406-771-8431
Mailing Address - Fax:406-771-8432
Practice Address - Street 1:1201 CENTRAL AVE
Practice Address - Street 2:STE 2
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3776
Practice Address - Country:US
Practice Address - Phone:406-771-8431
Practice Address - Fax:406-771-8432
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor