Healthcare Provider Details

I. General information

NPI: 1811169915
Provider Name (Legal Business Name): WHITEFISH CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5938 HWY 93 S
WHITEFISH MT
59937-8415
US

IV. Provider business mailing address

PO BOX 5114
WHITEFISH MT
59937-5114
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-2121
  • Fax: 406-863-9301
Mailing address:
  • Phone: 406-862-2121
  • Fax: 406-863-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1048
License Number StateMT

VIII. Authorized Official

Name: DR. RYAN M WIGNESS
Title or Position: DR.
Credential: D.C.
Phone: 406-862-2121