Healthcare Provider Details

I. General information

NPI: 1558389437
Provider Name (Legal Business Name): ROXANNE MARIE SIX DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BROADWAY ST
TOWNSEND MT
59644-2222
US

IV. Provider business mailing address

310 BROADWAY ST
TOWNSEND MT
59644-2222
US

V. Phone/Fax

Practice location:
  • Phone: 406-521-0078
  • Fax:
Mailing address:
  • Phone: 406-521-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06868
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1166
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number675
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: