Van Chiropractic Clinic, PC
Organization Active NPI Chiropractor · Billings, MT
NPI 1295869998 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1295869998
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 645 (MT)
- Legal business name
- VAN CHIROPRACTIC CLINIC, PC
- Practice address
- 1644 Broadwater Ave
Billings, MT 59102-5004 - Phone
- (406) 656-7000
- Fax
- (406) 656-8729
- NPI assigned
- Mar 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Grey Charles Gardner, DC
- Title
- Owner
- Phone
- (406) 656-7000
Practitioners 10
-
Tegan Fochs, LMT
-
Jason Aguayo, D.C.
-
Josie Lafond, LMT
-
Richard I Vande Veegaete, D.C.
-
Tavia Faith Watson, LMT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040401000635 | MT | Part B Supplier - Clinic/Group Practice | 7517959240 |
Receives reassigned benefits from 1 practitioner Practice locations: Billings, MT |
National Provider Directory
Locations
1644 Broadwater Ave
Billings, MT 59102
Phone (406) 545-2128
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 645 | MT | Yes |
Addresses
Primary practice location
1644 Broadwater Ave
Billings, MT 59102-5004
Mailing address
1644 Broadwater Ave
Billings, MT 59102-5004
Phone (406) 656-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CJ5000 | Other | MT | MEDICARE RR GROUP # |
| 41261 | Other | MT | BCBS PROVIDER NUMBER |
| 1750339164 | Other | MT | NPI # INDIVIDUAL FOR DR |
Other providers in Billings, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.