Lakeside Chiropractic Clinic PC
Organization Active NPI Chiropractor · Lakeside, MT
NPI 1215267752 · NPPES record last updated Mar 16, 2011
Key facts
- NPI
- 1215267752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHI 954 (MT)
- Legal business name
- LAKESIDE CHIROPRACTIC CLINIC PC
- Practice address
- 7176 Hwy 93 S
Lakeside, MT 59922 - Phone
- (406) 844-2151
- NPI assigned
- Jan 6, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Susan Kinkade Antley, D.C.
- Title
- Owner
- Phone
- (406) 844-2151
Practitioners 2
-
Susan Kinkade Antley, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100318000393 | MT | Part B Supplier - Clinic/Group Practice | 7214062090 |
Receives reassigned benefits from 1 practitioner Practice locations: Lakeside, MT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHI 954 | MT | Yes |
Addresses
Primary practice location
7176 Hwy 93 S
Lakeside, MT 59922
Mailing address
PO Box 648
Lakeside, MT 59922-0648
Other providers in Lakeside, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2011. 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.