Provider Demographics
NPI:1194890483
Name:PLEASANTS CHIROPRACTIC PC
Entity type:Organization
Organization Name:PLEASANTS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIRPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PLEASANTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-862-4364
Mailing Address - Street 1:533 SPOKANE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2780
Mailing Address - Country:US
Mailing Address - Phone:406-862-4364
Mailing Address - Fax:406-862-0894
Practice Address - Street 1:533 SPOKANE AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2780
Practice Address - Country:US
Practice Address - Phone:406-862-4364
Practice Address - Fax:406-862-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0161759Medicaid
MT40201OtherBCBS
MT04011821OtherSTATEFUND
MTT06628Medicare UPIN
MT40201OtherBCBS