Provider Demographics
NPI:1144938820
Name:RADIANT LIFE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:RADIANT LIFE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BOLEWARE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:682-365-7872
Mailing Address - Street 1:900 AMETHYST AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7838
Mailing Address - Country:US
Mailing Address - Phone:682-365-7872
Mailing Address - Fax:
Practice Address - Street 1:1361 ELM ST STE 3
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0920
Practice Address - Country:US
Practice Address - Phone:406-371-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty