NPIMap

Individual provider Active NPI

Charles Vickrey, LMT

  • Massage Therapist
  • Missoula, MT
National Provider Identifier
1649694092
Registry record updated Feb 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
6031 Issued in MT
Practice address
2801 Great Northern Loop
Missoula, MT 59808-1745
Phone
(406) 549-9100
NPI assigned
Feb 5, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 6031 MT Primary

Addresses

Primary practice location

2801 Great Northern Loop
Missoula, MT 59808-1745

Mailing address

2224 Rattlesnake Drive.
Missoula, MT 59802
Phone (970) 599-6665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6031MTMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
W Chiropractic Incorporated PastSince Apr 1, 2002 Accepting new patients
Tall Pines Chiropractic, P.C. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1649694092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 RATTLESNAKE DRIVE.",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59802",
            "telephone_number": "970-599-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 GREAT NORTHERN LOOP",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081745",
            "telephone_number": "406-549-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKREY",
        "first_name": "CHARLES",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-05",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MT",
            "license": "6031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.