Provider Demographics
NPI:1871546556
Name:CUTTING, SHANE ALBERT (DC)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ALBERT
Last Name:CUTTING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 MULLAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1827
Mailing Address - Country:US
Mailing Address - Phone:406-543-1955
Mailing Address - Fax:406-543-1506
Practice Address - Street 1:2419 MULLAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1827
Practice Address - Country:US
Practice Address - Phone:406-543-1955
Practice Address - Fax:406-543-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1047 CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0166270Medicaid
MT000040923OtherBLUE CROSS BLUE SHIELD
ID807199700Medicaid
MT0166260Medicaid