| Base Vitality PLLC | |
|
103 Ponderosa Ln Kalispell MT 59901-6833 | |
| (406) 220-5058 | |
| Not Available |
| Full Name | Base Vitality PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 103 Ponderosa Ln, Kalispell, Montana |
| Authorized Official Name and Position | Andrea L Emde (DR.) |
| Authorized Official Contact | 4062205058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Base Vitality PLLC 103 Ponderosa Ln Kalispell MT 59901-6833 Ph: (406) 220-5058 | Base Vitality PLLC 103 Ponderosa Ln Kalispell MT 59901-6833 Ph: (406) 220-5058 |
| NPI Number | 1114727237 |
|---|---|
| Provider Enumeration Date | 03/17/2025 |
| Last Update Date | 03/17/2026 |
| Certification Date | 03/17/2026 |
| Medicare PECOS PAC ID | 1254857873 |
|---|---|
| Medicare Enrollment ID | O20250428001555 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114727237 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 111N00000X | Chiropractor | (NU) | Secondary |
| Provider Name | Andrea L Emde |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1124538962 PECOS PAC ID: 8921410424 Enrollment ID: I20211118001975 |
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