Healthcare Provider Details

I. General information

NPI: 1245629211
Provider Name (Legal Business Name): DAVID DUCHARME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N MONTANA AVE STE A
HELENA MT
59602-7804
US

IV. Provider business mailing address

6325 BLACKFOOT DR
HELENA MT
59602-6516
US

V. Phone/Fax

Practice location:
  • Phone: 406-422-5817
  • Fax: 406-422-5928
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR-LAT-LIC-676
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: