Provider Demographics
NPI:1356422398
Name:KOMAC, JENNY M (DC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:M
Last Name:KOMAC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-1557
Mailing Address - Country:US
Mailing Address - Phone:406-297-2999
Mailing Address - Fax:406-297-7999
Practice Address - Street 1:110 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917
Practice Address - Country:US
Practice Address - Phone:406-297-2999
Practice Address - Fax:406-297-7999
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT919111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0164339Medicaid
MT0164346Medicaid
MT42131OtherBLUE CROSS BLUE SHIELD
MT0164346Medicaid