Healthcare Provider Details

I. General information

NPI: 1629158282
Provider Name (Legal Business Name): COLETTE MARIE KUKA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: