MEDICARE: DR. ROGER K AMUNDSON D.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	534	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	534	OTHER	MT	MONTANA LICENSE NUMBER

General Provider Information

NPI Number	:	1699843656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER K AMUNDSON D.C.

Provider Business Mailing Address
First Line	:	P.O. BOX 688
Second Line	:
City	:	MALTA
State	:	MT
Zip	:	59538
Country	:	US
Telephone Number	:	406-654-1130
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 SOUTH CENTRAL AVE
Second Line	:
City	:	MALTA
State	:	MT
Zip	:	59538
Country	:	US
Telephone Number	:	406-654-1130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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