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General NPI Number Information
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NPI Number | 1871965657
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Entity Type | Organization
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Legal Business Name | THE CHIROPRACTOR
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 2690 REST HAVEN DR
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City | WHITEFISH
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State | MT
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Zip | 59937-8621
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Country | US
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Telephone | 208-941-1779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4937
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City | WHITEFISH
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State | MT
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Zip | 59937-4937
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Country | US
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Telephone | 208-941-1779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY DAHL DUDLEY
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Credential | DC
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Telephone | 208-941-1779
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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 | CHI-CHI-LIC-3960
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License Number State | MT
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