Healthcare Provider Details

I. General information

NPI: 1760472815
Provider Name (Legal Business Name): FLORENCE FAMILY CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N 1ST ST
HAMILTON MT
59840-2124
US

IV. Provider business mailing address

514 N 1ST ST
HAMILTON MT
59840-2124
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-0237
  • Fax:
Mailing address:
  • Phone: 406-273-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1021
License Number StateMT

VIII. Authorized Official

Name: DR. LUCAS PERNSTEINER
Title or Position: DC AND PRESIDENT
Credential: D.C.
Phone: 406-273-0237