Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 643CHI | MT |
NPI | 1003972571 |
---|---|
Provider Name | Mr. Wade Anthony Darr |
First Address | Bozeman, MT 59718 |
Second Address | Bozeman, MT 59718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 07/09/2007 |