| NPI | 1811295447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY S. LILJENQUIST Owner/Chiropractor 208-678-2631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CH1A577) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ID ACC-78) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2011-03-07 |