Clearwater Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

CLEARWATER CHIROPRACTIC PC

Practice address

2330 South Higgins Ave
Suite 100
Missoula, MT 59801-6923

Phone

(406) 728-0330

Fax

(406) 728-0330

NPI assigned

Apr 6, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Glen Maricelli, D.CNPI 1790368645

Title

Doctor of Chiropractic

Phone

(406) 550-3493

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glen Maricelli, D.C.

  • Chiropractor
  • Missoula, MT
  • NPI 1790368645
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1013658566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SOUTH HIGGINS AVE",
            "address_2": "SUITE 100",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016923",
            "telephone_number": "406-728-0330",
            "fax_number": "406-728-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 SOUTH HIGGINS AVE",
            "address_2": "SUITE 100",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598016923",
            "telephone_number": "406-728-0330",
            "fax_number": "406-728-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-06",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A",
        "authorized_official_last_name": "MARICELLI",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "406-550-3493",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Anne Clater, LCSW
• Pamela Marie Clausen, LCPC
• Holly Patricia Claussen, DPT
• Dylan Claxton, MSW, LCSW
• Clear Light Psychotherapy, PLLC
• Danielle Nicole Clement
• Taylor Woods Clement, LCSW
• Cynthia Deann Cleveland, DPT
• Client Dedicated Services, Inc
• Justin Wade Cline, LCSW

• Chiropractor in Missoula, MT
• Providers in Missoula, MT by specialty
• Chiropractor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.