Provider Demographics
NPI:1154556058
Name:GARTH CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:GARTH CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARTH
Authorized Official - Suffix:II
Authorized Official - Credentials:DC, DACAN
Authorized Official - Phone:406-862-9100
Mailing Address - Street 1:6475 HWY 93 S STE 56
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8265
Mailing Address - Country:US
Mailing Address - Phone:406-862-6142
Mailing Address - Fax:
Practice Address - Street 1:6475 HWY 93 S STE 56
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8265
Practice Address - Country:US
Practice Address - Phone:406-862-6142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT791261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000004377OtherMEDICARE PTAN