=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831367374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRIEG CHIROPRACTIC CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2008
-----------------------------------------------------
Last Update Date | 02/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1070 N RUSSELL ST
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59808-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-541-8888
-----------------------------------------------------
Fax | 406-541-8891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1070 N RUSSELL ST
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59808-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-541-8888
-----------------------------------------------------
Fax | 406-541-8891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KEVIN B. KRIEG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 406-541-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 950
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------