| NPI | 1114124138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN HEARON Owner 208-377-9930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: ID C-4918) |
| Additional Taxonomies | 111NR0400X (Licence: ID C-4918) |
| 111N00000X Chiropractor (Licence: ID C-4918) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: ID C-4918) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: ID C-4918) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2020-08-22 |