Provider Demographics
NPI:1780984948
Name:BOZEMAN WELLNESS CENTER
Entity type:Organization
Organization Name:BOZEMAN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FOSKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-586-3556
Mailing Address - Street 1:2419 W MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3812
Mailing Address - Country:US
Mailing Address - Phone:406-586-3556
Mailing Address - Fax:406-586-9332
Practice Address - Street 1:2419 W MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3812
Practice Address - Country:US
Practice Address - Phone:406-586-3556
Practice Address - Fax:406-586-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty