Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgery, Foot & Ankle |
213ES0103X | 48 | Podiatry | |
Durable Medical Equipment & Medical Supplies |
332B00000X | 54 | Other Medical Supply Company |
| NPI # | 1699874727 |
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| LBN Legal business name | BITTERROOT FOOT & ANKLE CLINIC PC | ||||
| Authorized official | CHAD DICKEMORE - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 09/22/2006 | ||||
| Last updated | 03/05/2025 - More than a year ago | ||||
| Identifiers |
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