Organization
STILLWATER SPINE & SPORTS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYE K LEDUC D.C. (PRESIDENT)
(406) 756-7634
Entity
Organization
Contact information
Practice address
3171 HWY 93 N, SUITE C, KALISPELL, MT 59901
(406) 756-7634
(406) 756-7643
Mailing address
3171 HWY 93 N, SUITE C, KALISPELL, MT 59901
(406) 756-7634
(406) 756-7643
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
1014
MT
111NS0005X
Sports Physician Chiropractor
—
—
175F00000X
Naturopath
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000084625
MEDICARE GROUP
MT
Enumeration date
11/26/2007
Last updated
04/07/2021
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