Organization
VAN CHIROPRACTIC CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREY CHARLES GARDNER DC (OWNER)
(406) 656-7000
Entity
Organization
Contact information
Practice address
1644 BROADWATER AVE, BILLINGS, MT 59102-5004
(406) 656-7000
(406) 656-8729
Mailing address
1644 BROADWATER AVE, BILLINGS, MT 59102-5004
(406) 656-7000
(406) 656-8729
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
645
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750339164
NPI # INDIVIDUAL FOR DR
MT
01
—
41261
BCBS PROVIDER NUMBER
MT
01
—
CJ5000
MEDICARE RR GROUP #
MT
Enumeration date
03/15/2007
Last updated
08/22/2020
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