Provider Demographics
NPI:1699874727
Name:BITTERROOT FOOT & ANKLE CLINIC PC
Entity type:Organization
Organization Name:BITTERROOT FOOT & ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DICKEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-363-4214
Mailing Address - Street 1:330 N 10TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2318
Mailing Address - Country:US
Mailing Address - Phone:406-363-4214
Mailing Address - Fax:406-363-4354
Practice Address - Street 1:330 N 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2318
Practice Address - Country:US
Practice Address - Phone:406-363-4214
Practice Address - Fax:406-363-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT169213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT169 MTOtherSTATE LICENSE
MT169 MTOtherSTATE LICENSE