Provider Demographics
NPI:1245211002
Name:BRIDGE, ALAN W (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:BRIDGE
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 1:234 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-1910
Mailing Address - Country:US
Mailing Address - Phone:406-434-2262
Mailing Address - Fax:406-434-2475
Practice Address - Street 1:234 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1910
Practice Address - Country:US
Practice Address - Phone:406-434-2262
Practice Address - Fax:406-434-2475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000160693Medicaid
MT041540OtherBCBS