Provider Demographics
NPI:1578649968
Name:GUEST FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:GUEST FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-586-7641
Mailing Address - Street 1:2304 NORTH 7TH
Mailing Address - Street 2:SUITE E
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2571
Mailing Address - Country:US
Mailing Address - Phone:406-586-7641
Mailing Address - Fax:406-582-4181
Practice Address - Street 1:2304 N 7TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2597
Practice Address - Country:US
Practice Address - Phone:406-586-7641
Practice Address - Fax:406-585-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000085216OtherGROUP MEDICARE #
MT162279Medicaid
MTM000004672OtherMEDICARE PTAN