Provider Demographics
NPI:1033141353
Name:WAALE, DAVID H (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:WAALE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MAIN AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1956
Mailing Address - Country:US
Mailing Address - Phone:715-399-0330
Mailing Address - Fax:715-399-0331
Practice Address - Street 1:417 MAIN AVE
Practice Address - Street 2:STE 301
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1956
Practice Address - Country:US
Practice Address - Phone:715-399-0330
Practice Address - Fax:715-399-0331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38836900Medicaid
WI38836900Medicaid