Provider Demographics
NPI:1053582643
Name:MCKIERNAN CHIROPRACTIC & SPORTS INJURY CENTER PC
Entity type:Organization
Organization Name:MCKIERNAN CHIROPRACTIC & SPORTS INJURY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-756-2626
Mailing Address - Street 1:1031 SOUTH MAIN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-756-2626
Mailing Address - Fax:406-756-2625
Practice Address - Street 1:1031 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5635
Practice Address - Country:US
Practice Address - Phone:406-756-2626
Practice Address - Fax:406-756-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083844Medicare PIN