Provider Demographics
NPI:1164467486
Name:WATERS EDGE CHIROPRACTIC AND WELLNESS CENTER INC
Entity type:Organization
Organization Name:WATERS EDGE CHIROPRACTIC AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-543-1955
Mailing Address - Street 1:1831 SOUTH 3RD ST WEST
Mailing Address - Street 2:STE 201
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2454
Mailing Address - Country:US
Mailing Address - Phone:406-543-1955
Mailing Address - Fax:406-543-1506
Practice Address - Street 1:1831 S 3RD ST W STE 201
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2454
Practice Address - Country:US
Practice Address - Phone:406-543-1955
Practice Address - Fax:406-543-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807199700OtherIDAHO MEDICAID #
MT1871546556OtherINDIVIDUAL NPI #
MT0166260Medicaid
MT000040923OtherBCBS #
MT0166270Medicaid