Provider Demographics
NPI:1912171042
Name:ABUNDANTHEALTHFAMILYCHIROPRACTICPC
Entity Type:Organization
Organization Name:ABUNDANTHEALTHFAMILYCHIROPRACTICPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-585-7000
Mailing Address - Street 1:PO BOX 160502
Mailing Address - Street 2:
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-0502
Mailing Address - Country:US
Mailing Address - Phone:406-585-7000
Mailing Address - Fax:
Practice Address - Street 1:642 COTTONWOOD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9203
Practice Address - Country:US
Practice Address - Phone:406-585-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT350047684OtherRAIL ROAD MEDICARE
MT41811OtherBLUE CROSS/BLUE SHIELD
MT000004602OtherMEDICARE PROVIDER NUMBER
MT000084011OtherMEDICARE GROUP NUMBER