Provider Demographics
NPI:1770752040
Name:VALLEY FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:VALLEY FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAZUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-549-2771
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-1176
Mailing Address - Country:US
Mailing Address - Phone:406-549-2771
Mailing Address - Fax:406-549-3925
Practice Address - Street 1:3880 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-6306
Practice Address - Country:US
Practice Address - Phone:406-549-2771
Practice Address - Fax:406-549-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty