Provider Demographics
NPI:1275807588
Name:WATHAN, JESSE PAUL (DC)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:PAUL
Last Name:WATHAN
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 1:2593 US HIGHWAY 2 E
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:406-890-2234
Practice Address - Street 1:2593 US HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-9507
Practice Address - Country:US
Practice Address - Phone:406-890-2212
Practice Address - Fax:406-890-2234
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor