Organization
WATERS EDGE CHIROPRACTIC AND WELLNESS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANIE A TRIPP (OFFICE COORDINATOR)
(406) 543-1955
Entity
Organization
Contact information
Practice address
1831 S 3RD ST W STE 201, MISSOULA, MT 59801-2454
(406) 543-1955
(406) 543-1506
Mailing address
1831 SOUTH 3RD ST WEST, STE 201, MISSOULA, MT 59801-2454
(406) 543-1955
(406) 543-1506
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1047
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000040923
BCBS #
MT
05
—
0166260
—
MT
05
—
0166270
—
MT
01
—
1871546556
INDIVIDUAL NPI #
MT
01
—
807199700
IDAHO MEDICAID #
ID
Enumeration date
06/19/2006
Last updated
06/11/2025
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