Provider Demographics
NPI:1891811733
Name:DILLON BACK & NECK CLINIC PC
Entity type:Organization
Organization Name:DILLON BACK & NECK CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BELICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-683-9600
Mailing Address - Street 1:330 S IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2532
Mailing Address - Country:US
Mailing Address - Phone:406-683-9600
Mailing Address - Fax:
Practice Address - Street 1:330 S IDAHO ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-2532
Practice Address - Country:US
Practice Address - Phone:406-683-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0162945Medicaid
MT350054899OtherRAILROAD MEDICARE
MT0162928Medicaid
MT41921OtherBLUE CROSS BLUE SHIELD
MTU73510Medicare UPIN
MT0162945Medicaid