Provider Demographics
NPI:1841693553
Name:WADE DARR, LLC
Entity type:Organization
Organization Name:WADE DARR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-600-5039
Mailing Address - Street 1:105 9TH AVE SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-0000
Mailing Address - Country:US
Mailing Address - Phone:701-842-3100
Mailing Address - Fax:
Practice Address - Street 1:20 W BROADWAY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6015
Practice Address - Country:US
Practice Address - Phone:701-774-3635
Practice Address - Fax:701-774-3632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WADE DARR, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty