Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 634 | MT |
N | 111NI0013X | Independent Medical Examiner | 634 | MT |
NPI | 1518949478 |
---|---|
Provider Name | Vincent Jerry Maddio |
First Address | Helena, MT 59601-3318 |
Second Address | Helena, MT 59601-3318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 24/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U21062 | (02) | MT |