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General NPI Number Information
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NPI Number | 1164673497
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Entity Type | Organization
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Legal Business Name | OLC, LLC
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 307 E PARK AVE STE 204
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City | ANACONDA
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State | MT
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Zip | 59711-2351
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Country | US
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Telephone | 406-459-6785
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Fax | 406-563-0424
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Provider Business Mailing Address
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Address Line | 307 E PARK AVE STE 204
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City | ANACONDA
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State | MT
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Zip | 59711-2351
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Country | US
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Telephone | 406-459-6785
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Fax | 406-563-0424
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. MARY ELLEN BURTON
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Credential | DC
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Telephone | 406-459-6785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHI-CHI-LIC-2372
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License Number State | MT
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