Provider Demographics
NPI:1104097351
Name:GRIZZLY SPINE PAIN AND REHAB, PC
Entity type:Organization
Organization Name:GRIZZLY SPINE PAIN AND REHAB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JAHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-755-4488
Mailing Address - Street 1:3 MERIDIAN CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4240
Mailing Address - Country:US
Mailing Address - Phone:406-755-4488
Mailing Address - Fax:406-755-4481
Practice Address - Street 1:3 MERIDIAN CT
Practice Address - Street 2:SUITE 2
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4240
Practice Address - Country:US
Practice Address - Phone:406-755-4488
Practice Address - Fax:406-755-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
MT10947261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation