MEDICARE: MISSOULA FAMILY CHIROPRACTIC LLC

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	1240	MT

General Provider Information

NPI Number	:	1851692263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOULA FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1120 W CENTRAL AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-7925
Country	:	US
Telephone Number	:	406-552-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 W CENTRAL AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-7925
Country	:	US
Telephone Number	:	406-552-7043
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. TORRIE MAUERMAN
Credential	:	D.C.
Telephone Number	:	406-552-7043

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	03/27/2015

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