Provider Demographics
NPI:1124303870
Name:VISSCHER, NOAH (MSA)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:VISSCHER
Suffix:
Gender:M
Credentials:MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MILL TOWN LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5144
Mailing Address - Country:US
Mailing Address - Phone:406-587-1167
Mailing Address - Fax:406-219-0935
Practice Address - Street 1:145 MILL TOWN LOOP STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5144
Practice Address - Country:US
Practice Address - Phone:406-587-1167
Practice Address - Fax:406-219-0935
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61123606171100000X
MTMED-ACU-LIC-104849171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist