MEDICARE: TREASURE STATE CHIROPRACTIC PC

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

General Provider Information

NPI Number	:	1588145494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE STATE CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	7935 MT HIGHWAY 35 STE 201
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-5711
Country	:	US
Telephone Number	:	406-420-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	7935 MT HIGHWAY 35 STE 201
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-5711
Country	:	US
Telephone Number	:	406-420-2811
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEGAN SHOULTZ
Credential	:
Telephone Number	:	406-420-2811

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	11/05/2018

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