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General NPI Number Information
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NPI Number | 1649607565
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Entity Type | Organization
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Legal Business Name | GRIZZLY SPORTS AND FAMILY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 1934 BROOKS ST
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City | MISSOULA
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State | MT
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Zip | 59801-6644
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Country | US
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Telephone | 406-531-6287
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Fax | 406-493-1109
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Provider Business Mailing Address
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Address Line | PO BOX 759
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City | MISSOULA
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State | MT
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Zip | 59806-0759
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Country | US
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Telephone | 406-531-6287
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Fax | 406-493-1109
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | ANTHONY HAMILTON SANDERSON
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Credential | DC
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Telephone | 406-531-6287
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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 | CHICHILIC2874
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License Number State | MT
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