Individual
MS. GINA MARIE WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.M.T
Contact information
Practice address
4 1ST ST E STE 100, KALISPELL, MT 59901-4554
(406) 261-7528
Mailing address
4 1ST ST E STE 100, KALISPELL, MT 59901-4554
(406) 261-7528
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
708
CO
174400000X
Specialist
Primary
708
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000022444
STATE FUND
MT
Enumeration date
10/01/2013
Last updated
10/01/2013
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