Healthcare Provider Details

I. General information

NPI: 1497809552
Provider Name (Legal Business Name): DALE A SPEISER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MILWAUKEE AVE
DEER LODGE MT
59722-1085
US

IV. Provider business mailing address

304 MILWAUKEE AVE
DEER LODGE MT
59722-1085
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-9545
  • Fax: 406-846-9545
Mailing address:
  • Phone: 406-846-9545
  • Fax: 406-846-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1080CHI
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: