MEDICARE: DR. ANTHONY J POPP JR. DC

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	910CHI	MT
2	111N00000X	Chiropractor	CHIA885	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA7886	OTHER	MT	RAILROAD MEDICARE -GROUP
3	P0007206	OTHER	MT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42181	OTHER		BCBS

General Provider Information

NPI Number	:	1295728814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY J POPP JR. DC

Provider Business Mailing Address
First Line	:	5 S MERIDIAN RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4263
Country	:	US
Telephone Number	:	406-755-1001
Fax Number	:	406-755-1862

Provider Business Practice Location Address
First Line	:	5 S MERIDIAN RD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4263
Country	:	US
Telephone Number	:	406-755-1001
Fax Number	:	406-755-1862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	11/27/2007

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