Provider Demographics
NPI:1811183916
Name:EUREKA FAMILY CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:EUREKA FAMILY CHIROPRACTIC P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOMAC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-297-2999
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-1557
Mailing Address - Country:US
Mailing Address - Phone:406-297-2999
Mailing Address - Fax:406-297-7999
Practice Address - Street 1:110 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917
Practice Address - Country:US
Practice Address - Phone:406-297-2999
Practice Address - Fax:406-297-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000082598Medicare PIN