| NPI | 1396171187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANNE DORN Owner 208-342-7136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA1559) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA1560) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: ID CHIA1559) | |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2021-03-15 |