Healthcare Provider Details

I. General information

NPI: 1669019568
Provider Name (Legal Business Name): ENSO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BRIDGER DR UNIT J
BOZEMAN MT
59715-2303
US

IV. Provider business mailing address

875 BRIDGER DR UNIT J
BOZEMAN MT
59715-2303
US

V. Phone/Fax

Practice location:
  • Phone: 406-585-9113
  • Fax: 406-585-9103
Mailing address:
  • Phone: 406-585-9113
  • Fax: 406-585-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATIE M COOK-BRETSON
Title or Position: OWNER
Credential: LAC, LMT
Phone: 406-585-9113