| NPI | 1295121747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GRIFFIN Owner 208-887-6810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID APPN-28089) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA--874) |
| Enumeration Date | 2015-04-11 |
| Last Update Date | 2015-04-11 |