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NPI 1457424749

NPI 1457424749 : WADE T FIKE D.C. : BILLINGS, MT

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General NPI Number Information
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    NPI Number           |    1457424749
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    Entity Type          |    Individual 
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    Provider Name        |    WADE T FIKE D.C.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    11/16/2006
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    Last Update Date     |    06/03/2015
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Provider Practice Location Address
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    Address Line         |    1225 BROADWATER AVE 
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    City                 |    BILLINGS
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    State                |    MT
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    Zip                  |    59102-5319
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    Country              |    US
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    Telephone            |    406-259-3311
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    Fax                  |    406-259-3331
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Provider Business Mailing Address
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    Address Line         |    2607 TRAILS END RD 
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    City                 |    BILLINGS
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    State                |    MT
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    Zip                  |    59106-9508
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    Country              |    US
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    Telephone            |    406-254-0609
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    Fax                  |    406-254-0609
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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        |    111NN1001X
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    Taxonomy Name        |    Nutrition Chiropractor
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    License Number       |    807
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    License Number State |    MT
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