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General NPI Number Information
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NPI Number | 1821492125
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Entity Type | Organization
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Legal Business Name | KIM SALLOUX LAC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 109 W CALLENDER SUITE 2E
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City | LIVINGSTON
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State | MT
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Zip | 59047
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Country | US
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Telephone | 415-846-7288
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Fax |
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Provider Business Mailing Address
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Address Line | 214 S 7TH
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City | LIVINGSTON
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State | MT
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Zip | 59047
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Country | US
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Telephone | 415-846-7288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM GRETHER SALLOUX
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Credential | LAC
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Telephone | 415-845-7288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 32222
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License Number State | MT
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