Healthcare Provider Details

I. General information

NPI: 1457424749
Provider Name (Legal Business Name): WADE T FIKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BROADWATER AVE
BILLINGS MT
59102-5319
US

IV. Provider business mailing address

2607 TRAILS END RD
BILLINGS MT
59106-9508
US

V. Phone/Fax

Practice location:
  • Phone: 406-259-3311
  • Fax: 406-259-3331
Mailing address:
  • Phone: 406-254-0609
  • Fax: 406-254-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number807
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: