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Individual

DOUGLAS S VANDOLAH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
30 N MAIN AVE, CHOTEAU, MT 59422
(406) 466-5665
Mailing address
PO BOX 1448, CHOTEAU, MT 59422-1448
(406) 466-5665

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
902
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000161517
MT
05
0000161534
MT
01
41931
BLUE CROSS/BLUE SHIELD MT
MT
01
M000004415
MEDICARE PTAN
MT
Enumeration date
09/22/2005
Last updated
10/26/2010
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