| NPI | 1912133885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM A WALLACE Owner/Physician 406-327-0269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MT 8667) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MT 11754) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MT 11801) | |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2009-06-05 |