| NPI | 1063826535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER REIDHEAD Owner 208-323-1313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: ID CHIA-452) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2025-06-20 |