MEDICARE: BACK ON TRACK FAMILY CHIROPRACTIC CENTER, INC.

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

Other Identifiers

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

General Provider Information

NPI Number	:	1811188907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK ON TRACK FAMILY CHIROPRACTIC CENTER, INC.

Provider Business Mailing Address
First Line	:	# 5 SOUTH 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 SOUTH 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	:	PRESIDENT
Name	:	DR. ANTHONY JOSEPH POPP JR.
Credential	:	D.C.
Telephone Number	:	406-755-1001

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	01/26/2023

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