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General NPI Number Information
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NPI Number | 1164467486
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Entity Type | Organization
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Legal Business Name | WATERS EDGE CHIROPRACTIC AND WELLNESS CENTER INC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1831 S 3RD ST W STE 201
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City | MISSOULA
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State | MT
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Zip | 59801-2454
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Country | US
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Telephone | 406-543-1955
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Fax | 406-543-1506
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Provider Business Mailing Address
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Address Line | 1831 SOUTH 3RD ST WEST STE 201
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City | MISSOULA
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State | MT
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Zip | 59801-2454
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Country | US
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Telephone | 406-543-1955
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Fax | 406-543-1506
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | JEANIE A TRIPP
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Credential |
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Telephone | 406-543-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1047
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License Number State | MT
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