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General NPI Number Information
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NPI Number | 1043496755
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Entity Type | Organization
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Legal Business Name | BACK AND NECK CLINIC OF GREAT FALLS, P.C.
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 205 9TH AVE S SUITE 105
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City | GREAT FALLS
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State | MT
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Zip | 59405-4071
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Country | US
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Telephone | 406-771-8431
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Fax | 406-771-8432
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Provider Business Mailing Address
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Address Line | 205 9TH AVE S SUITE 105
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City | GREAT FALLS
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State | MT
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Zip | 59405-4071
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Country | US
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Telephone | 406-771-8431
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Fax | 406-771-8432
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN CHARLES OTHEIM
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Credential | D.C.
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Telephone | 406-771-8431
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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 | 941
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License Number State | MT
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