MEDICARE: BACK AND NECK CLINIC OF GREAT FALLS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	941	MT

General Provider Information

NPI Number	:	1043496755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK AND NECK CLINIC OF GREAT FALLS, P.C.

Provider Business Mailing Address
First Line	:	205 9TH AVE S
Second Line	:	SUITE 105
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4071
Country	:	US
Telephone Number	:	406-771-8431
Fax Number	:	406-771-8432

Provider Business Practice Location Address
First Line	:	205 9TH AVE S
Second Line	:	SUITE 105
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4071
Country	:	US
Telephone Number	:	406-771-8431
Fax Number	:	406-771-8432

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN CHARLES OTHEIM
Credential	:	D.C.
Telephone Number	:	406-771-8431

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	06/05/2024

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