| NPI | 1982462008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BRADLEY Owner 208-992-5212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2025-12-04 |