Provider Demographics
NPI:1063832137
Name:WADE DARR LLC
Entity Type:Organization
Organization Name:WADE DARR LLC
Other - Org Name:WATFORD CITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-600-5039
Mailing Address - Street 1:105 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-0589
Mailing Address - Country:US
Mailing Address - Phone:406-600-5039
Mailing Address - Fax:
Practice Address - Street 1:105 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-0589
Practice Address - Country:US
Practice Address - Phone:406-600-5039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty