Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1080CHI | MT |
NPI | 1497809552 |
---|---|
Provider Name | Dr. Dale A Speiser |
First Address | Deer Lodge, MT 59722-1085 |
Second Address | Deer Lodge, MT 59722-1085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1080CHI | CHIROPRACTIC LICENCE (01) | MT |
2514 | CHIROPRACTIC LICENCE (01) | OH |
2658 | CHIROPRACTIC LICENCE (01) | WA |
287218-1202 | CHIROPRACTIC LICENCE (01) | UT |