Susan Kinkade Antley, D.C.
Individual provider
Active NPI
Chiropractor · Lakeside, MT
NPI 1457401895 · NPPES record last updated Mar 16, 2011
Key facts
- NPI
- 1457401895
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHI 954 (MT)
- Practice address
- 7176 Highway 93 South
Lakeside, MT 59922
- Phone
- (406) 844-2151
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20100311000724 |
MT |
Practitioner - Chiropractic |
0547395857 |
Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| CHI 954 | MT | MD | Chiropractor |
| 954 | MT | MD | Occupational Therapist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Chiropractor |
111N00000X |
CHI 954 |
MT |
Yes |
Addresses
Primary practice location
7176 Highway 93 South
Lakeside, MT 59922
Mailing address
PO Box 648
Lakeside, MT 59922-0648
Phone (406) 844-2151
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 0000040033 | Other | MT | BLUE CROSS BLUE SHIELD |
| 0000163999 | Medicaid | MT | |