Individual
JERALD DALE WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1520 3RD ST NW, SUITE E, GREAT FALLS, MT 59404
(406) 727-5757
(406) 727-7006
Mailing address
PO BOX 363, VAUGHN, MT 59487
(406) 727-5757
(406) 727-7006
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
786
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00040903
BLUE CROSS BLUE SHIELD
MT
Enumeration date
12/26/2006
Last updated
07/08/2007
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