NPIMap

Organization Active NPI

Montana Spine and Neurodevelopment Center

  • Chiropractor
  • Kalispell, MT
National Provider Identifier
1861153280
Registry record updated Jan 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
MONTANA SPINE AND NEURODEVELOPMENT CENTER
Practice address
2593 Hwy 2 East Suite 1
Kalispell, MT 59901
Phone
(406) 890-2214
NPI assigned
Jan 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2023

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

Authorized official

Name
Angela Wathan, DCNPI 1487630620
Title
President
Phone
(406) 890-2214

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X

Addresses

Primary practice location

2593 Hwy 2 East Suite 1
Kalispell, MT 59901

Mailing address

2593 US Highway 2 E Ste 1
Kalispell, MT 59901-9507
Phone (406) 890-2214

Other practice location 1

2593 US Highway 2 E Ste 1
Kalispell, MT 59901-9507
Phone (406) 890-2214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221212000822 MT Part B Supplier - Clinic/Group Practice 7911376157 Receives reassigned benefits from 3 practitioners
Practice locations: Kalispell, MT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672617600000",
    "number": "1861153280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2593 US HIGHWAY 2 E STE 1",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599019507",
            "telephone_number": "406-890-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2593 HWY 2 EAST SUITE 1",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "59901",
            "telephone_number": "406-890-2214"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2593 US Highway 2 E Ste 1",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599019507",
            "country_code": "US",
            "telephone_number": "406-890-2214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MONTANA SPINE AND NEURODEVELOPMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-07",
        "last_updated": "2023-01-02",
        "certification_date": "2023-01-02",
        "status": "A",
        "authorized_official_last_name": "WATHAN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "406-890-2214",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.