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Organization

MISSOULA OSTEOPATHIC CLINIC, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SAM A WALLACE D.O. (OWNER/PHYSICIAN)
(406) 327-0269
Entity
Organization

Contact information

Practice address
341 W PINE ST, MISSOULA, MT 59802-4119
(406) 327-0269
(406) 327-0264
Mailing address
341 W PINE ST, MISSOULA, MT 59802-4119
(406) 327-0269
(406) 327-0264

Taxonomy

Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
11754
MT
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
11801
MT
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
8667
MT

Other

Enumeration date
06/05/2009
Last updated
06/05/2009
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