Healthcare Provider Details

I. General information

NPI: 1174756431
Provider Name (Legal Business Name): KUKA CHIROPRACTIC CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 7TH ST S
GREAT FALLS MT
59405-4026
US

IV. Provider business mailing address

906 7TH ST S
GREAT FALLS MT
59405-4026
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-9101
  • Fax: 406-727-9101
Mailing address:
  • Phone: 406-727-9101
  • Fax: 406-727-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number612
License Number StateMT

VIII. Authorized Official

Name: DR. COLETTE MARIE KUKA
Title or Position: OWNER
Credential: D.C.
Phone: 406-727-9101