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General NPI Number Information
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NPI Number | 1003243346
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Entity Type | Individual
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Provider Name | GINA MARIE WADE C.M.T
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Gender | Female
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 4 1ST ST E STE 100
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City | KALISPELL
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State | MT
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Zip | 59901-4554
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Country | US
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Telephone | 406-261-7528
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Fax |
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Provider Business Mailing Address
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Address Line | 4 1ST ST E STE 100
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City | KALISPELL
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State | MT
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Zip | 59901-4554
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Country | US
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Telephone | 406-261-7528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 708
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 708
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License Number State | MT
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