Individual
DR. SUSAN KINKADE ANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
7176 HIGHWAY 93 SOUTH, LAKESIDE, MT 59922
(406) 844-2151
Mailing address
PO BOX 648, LAKESIDE, MT 59922-0648
(406) 844-2151
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHI 954
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000040033
BLUE CROSS BLUE SHIELD
MT
05
—
0000163999
—
MT
Enumeration date
01/10/2007
Last updated
03/16/2011
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