Provider Demographics
NPI:1376922781
Name:MEDICINE HANDS WELLNESS, PC
Entity Type:Organization
Organization Name:MEDICINE HANDS WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:KAYE WATERSTRAAT
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-587-6264
Mailing Address - Street 1:1276 N 15TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3289
Mailing Address - Country:US
Mailing Address - Phone:406-587-6264
Mailing Address - Fax:406-587-3556
Practice Address - Street 1:1276 N 15TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3289
Practice Address - Country:US
Practice Address - Phone:406-587-6264
Practice Address - Fax:406-587-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-1817111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTCHI-CHI-LIC-1817OtherCHIROPRACTIC LICENSE
M011003351OtherMEDICARE PTAN
1952675431OtherNPI - INDIVIDUAL