| NPI | 1366908949 |
|---|---|
| Other Name | COEUR D ALENE SPINE AND SPORT |
| Entity Type | Organization |
| Authorized Contact | MICHAEL ALAN LUDWIG Owner 208-765-0156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2021-08-25 |