| NPI | 1033562319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GRIFFIN Owner/President 208-887-6810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP-1639A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-874) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |