MEDICARE: ABSOLUTE HEALTH FAMILY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1101	MT

General Provider Information

NPI Number	:	1194901082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE HEALTH FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	913 SW HIGGINS AVE STE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1423
Country	:	US
Telephone Number	:	406-549-7171
Fax Number	:	406-549-6868

Provider Business Practice Location Address
First Line	:	913 SW HIGGINS AVE STE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1423
Country	:	US
Telephone Number	:	406-549-7171
Fax Number	:	406-549-6868

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	MICHAEL G JOHNSON
Credential	:	DC
Telephone Number	:	406-549-7171

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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