Provider Demographics
NPI:1326201054
Name:PICKERING, FRED WAYNE (DO)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:WAYNE
Last Name:PICKERING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0685
Mailing Address - Country:US
Mailing Address - Phone:406-425-1843
Mailing Address - Fax:
Practice Address - Street 1:13TH STREET
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-0685
Practice Address - Country:US
Practice Address - Phone:406-425-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT891111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner