Provider Demographics
NPI:1760472815
Name:FLORENCE FAMILY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:FLORENCE FAMILY CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DC AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERNSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-273-0237
Mailing Address - Street 1:514 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2124
Mailing Address - Country:US
Mailing Address - Phone:406-273-0237
Mailing Address - Fax:
Practice Address - Street 1:514 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2124
Practice Address - Country:US
Practice Address - Phone:406-273-0237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000004498Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER