Provider Demographics
NPI:1679637359
Name:GOLIE, DAVID J (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:GOLIE
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 1:120 S 5TH ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2700
Mailing Address - Country:US
Mailing Address - Phone:406-375-0800
Mailing Address - Fax:406-375-0700
Practice Address - Street 1:120 S 5TH ST
Practice Address - Street 2:STE. 102
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2700
Practice Address - Country:US
Practice Address - Phone:406-375-0800
Practice Address - Fax:406-375-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000163267Medicaid
MT40481OtherBLUE CROSS BLUE SHIELD