Provider Demographics
NPI:1821192188
Name:ROBINSON, WANDA M (DC)
Entity Type:Individual
Prefix:MISS
First Name:WANDA
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MERIDIAN CT STE 1
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4245
Mailing Address - Country:US
Mailing Address - Phone:406-607-6105
Mailing Address - Fax:406-607-6106
Practice Address - Street 1:15 MERIDIAN CT STE 1
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4245
Practice Address - Country:US
Practice Address - Phone:406-607-6105
Practice Address - Fax:406-607-6106
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0166345Medicaid
MT000040813OtherBLUE CROSS
MTP0221637OtherRAILROAD RETIREMENT MEDICARE
MTP0221637OtherRAILROAD RETIREMENT MEDICARE