Provider Demographics
NPI:1457424749
Name:FIKE, WADE T (DC)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:T
Last Name:FIKE
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 1:2607 TRAILS END RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-9508
Mailing Address - Country:US
Mailing Address - Phone:406-254-0609
Mailing Address - Fax:406-254-0609
Practice Address - Street 1:1225 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5319
Practice Address - Country:US
Practice Address - Phone:406-259-3311
Practice Address - Fax:406-259-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT807111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000041181OtherBLUE CROSS BLUE SHIELD
MTU64335Medicare UPIN