Individual
MS. ELLEN LUCILLE WICKLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
206 MAIN ST SW, RONAN, MT 59864
(406) 676-0170
(406) 676-0160
Mailing address
206 MAIN ST SW, RONAN, MT 59864
(406) 676-0170
(406) 676-0160
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1050
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40743
BCBS
—
01
—
P00067474
RR MEDICARE
—
Enumeration date
11/17/2006
Last updated
07/08/2007
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