Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4548 | MT |
NPI | 1003324435 |
---|---|
Provider Name | Craig Ullman |
First Address | Great Falls, MT 59404-3134 |
Second Address | Great Falls, MT 59404-3134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2018 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073791547 | (05) | MT |