Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3427 | MT |
NPI | 1003212465 |
---|---|
Provider Name | Jack Lundbohm |
First Address | Columbia Falls, MT 59912-3602 |
Second Address | Columbia Falls, MT 59912-3602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 02/05/2017 |