Individual
DR. IVAN T VAN EERDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
225 HICKORY ST, MISSOULA, MT 59801-1856
(406) 541-6400
(406) 728-8467
Mailing address
225 HICKORY ST, MISSOULA, MT 59801-1856
(406) 541-6400
(406) 728-8467
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
946
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0165503
—
MT
05
—
0165512
—
MT
01
—
40053
BLUE CROSSBLUE SHIELD
MT
01
—
ACN617836
ACN
MT
Enumeration date
12/14/2006
Last updated
07/08/2007
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