Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 919 | MT |
N | 111NR0200X | Radiology | 919 | MT |
N | 213ER0200X | Radiology | 919 | MT |
NPI | 1356422398 |
---|---|
Provider Name | Jenny M Komac |
First Address | Eureka, MT 59917-1557 |
Second Address | Eureka, MT 59917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 25/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0164339 | (05) | MT |
0164346 | (05) | MT |
42131 | BLUE CROSS BLUE SHIELD (01) | MT |