| NPI | 1639280712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE CAREAGA Billing Manager 208-343-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-559) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-802) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |