Provider Demographics
NPI:1114114030
Name:WATHAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WATHAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-890-2212
Mailing Address - Street 1:2593 US HIGHWAY 2 E STE 1
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9507
Mailing Address - Country:US
Mailing Address - Phone:406-890-2212
Mailing Address - Fax:
Practice Address - Street 1:221 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3013
Practice Address - Country:US
Practice Address - Phone:406-890-2212
Practice Address - Fax:406-890-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15378Medicare PIN