Provider Demographics
NPI:1043494354
Name:BACK COUNTRY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:BACK COUNTRY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-696-9874
Mailing Address - Street 1:3202 HENESTA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7021
Mailing Address - Country:US
Mailing Address - Phone:406-294-5294
Mailing Address - Fax:
Practice Address - Street 1:3202 HENESTA DR
Practice Address - Street 2:SUITE D
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7021
Practice Address - Country:US
Practice Address - Phone:406-294-5294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528289451OtherNPI - INDIVIDUAL