Healthcare Provider Details

I. General information

NPI: 1184000655
Provider Name (Legal Business Name): ADVANCED CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 12TH AVE S STE 104
GREAT FALLS MT
59405-4600
US

IV. Provider business mailing address

1301 12TH AVE S STE 104
GREAT FALLS MT
59405-4600
US

V. Phone/Fax

Practice location:
  • Phone: 406-315-3037
  • Fax: 406-315-2467
Mailing address:
  • Phone: 406-315-3037
  • Fax: 406-315-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number408
License Number StateMT

VIII. Authorized Official

Name: LEE HUDSON
Title or Position: OWNER
Credential: D.C.
Phone: 406-315-3037