Black Spire PLLC
Organization Active NPI Chiropractor · Livingston, MT
NPI 1104540574 · NPPES record last updated Nov 22, 2022
Key facts
- NPI
- 1104540574
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- BLACK SPIRE PLLC
- Practice address
- 403 W Park St
Livingston, MT 59047-2635 - Phone
- (406) 548-7347
- NPI assigned
- Sep 29, 2022
- Organization subpart
- No
Authorized official
- Name
- Brady Scott Raney, DC
- Title
- Owner/Practioner
- Phone
- (406) 222-6668
Practitioners 2
-
David Alan Thiry, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221213001717 | MT | Part B Supplier - Clinic/Group Practice | 3577932607 |
Receives reassigned benefits from 1 practitioner Practice locations: Livingston, MT |
National Provider Directory
Locations
403 W Park St
Livingston, MT 59047
Phone (406) 222-6668
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
403 W Park St
Livingston, MT 59047-2635
Mailing address
403 W Park St
Livingston, MT 59047-2635
Phone (406) 548-7347
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000679711 | Medicaid | MT |
Other names
- Raney Chiropractic
Other providers in Livingston, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.