Provider Demographics
NPI:1982723060
Name:ACUPUNCTURE CLINIC OF MISSOULA INC.
Entity Type:Organization
Organization Name:ACUPUNCTURE CLINIC OF MISSOULA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SEABER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-728-1600
Mailing Address - Street 1:3031 S RUSSELL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8523
Mailing Address - Country:US
Mailing Address - Phone:406-728-1600
Mailing Address - Fax:406-327-6702
Practice Address - Street 1:3031 S RUSSELL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8523
Practice Address - Country:US
Practice Address - Phone:406-728-1600
Practice Address - Fax:406-327-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00986-7OtherBLUE CROSS BLUE SHIELD