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General NPI Number Information
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NPI Number | 1043494354
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Entity Type | Organization
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Legal Business Name | BACK COUNTRY FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 3202 HENESTA DR SUITE D
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City | BILLINGS
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State | MT
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Zip | 59102-7021
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Country | US
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Telephone | 406-294-5294
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Fax |
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Provider Business Mailing Address
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Address Line | 3202 HENESTA DR SUITE D
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City | BILLINGS
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State | MT
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Zip | 59102-7021
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Country | US
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Telephone | 406-294-5294
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. TARA M. LEMKE
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Credential | D.C.
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Telephone | 406-696-9874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1145
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License Number State | MT
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