Organization
ACTIVE LIFE CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN CODY MCINTOSH D.C. (OWNER)
(406) 214-9706
Entity
Organization
Contact information
Practice address
1070 N RUSSELL ST, MISSOULA, MT 59808
(406) 541-7300
(406) 541-8891
Mailing address
1070 N RUSSELL ST, MISSOULA, MT 59808
(406) 541-7300
(406) 541-8891
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3398
MT
Other
Enumeration date
01/08/2015
Last updated
01/08/2015
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