Healthcare Provider Details

I. General information

NPI: 1972352854
Provider Name (Legal Business Name): CHIDOCHASHE CHIKWAVA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 11TH AVE S STE 24
GREAT FALLS MT
59405-5263
US

IV. Provider business mailing address

2405 S LAUREL ST
PORT ANGELES WA
98362-2529
US

V. Phone/Fax

Practice location:
  • Phone: 406-868-2644
  • Fax:
Mailing address:
  • Phone: 406-945-3134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: