| NPI | 1164837647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY W CANNON Chiropractic Physician, Owner 208-557-1880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID CHIA-1580) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2014-06-24 |