Provider Demographics
NPI:1386287795
Name:INTERMOUNTAIN CHIROPRACTIC
Entity type:Organization
Organization Name:INTERMOUNTAIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HANSING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-449-0814
Mailing Address - Street 1:62 S LAST CHANCE GULCH ST. #A
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601
Mailing Address - Country:US
Mailing Address - Phone:406-449-0814
Mailing Address - Fax:
Practice Address - Street 1:62 S LAST CHANCE GULCH ST. #A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-449-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty