# MISSOULA OSTEOPATHIC CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326487430
- **Authorized official:** SAM ARON WALLACE D.O. (OWNER/PHYSICIAN)
- **Authorized official phone:** (406) 327-0269

## Contact information

- **Practice address:** 341 W PINE ST, MISSOULA, MT 59802-4119
- **Practice address phone:** (406) 327-0269
- **Practice address fax:** (406) 327-0264
- **Mailing address:** 341 W PINE ST, MISSOULA, MT 59802-4119
- **Mailing address phone:** (406) 327-0269
- **Mailing address fax:** (406) 327-0264

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MED-PHYS-LIC-8667 | MT | Yes |

## Other

- **Enumeration date:** 06/21/2013
- **Last updated:** 11/10/2022