NPI age
18 years
Enumerated 2008-03-24
● Active Type 2 · Organization
Eastern Idaho Spine Center
Eastern Idaho Spine Center is 1 of 19 rehabilitation practitioner organizations in Idaho.
Primary specialty
Rehabilitation Practitioner
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Mangrum
Owner
Last NPPES update
2008-06-06
Source: monthly bulk 2026-05
How this organization compares
Across 19 active rehabilitation practitioner providers in Idaho.
NPI age
18 years
↑ 11 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2008 → 2026
2008-03Enumerated in NPPES
2008
2026
Where they practice
Primary practice location
2860 Channing Way, Ste 112
Idaho Falls, ID 834047531
Mailing address
2860 Channing Way, Ste 112
Idaho Falls, ID 834047531
Authorized official
Shane Christian Mangrum, M.D.
Owner
📞 2085354343
Individual providers at this organization
9 individual providers on file at this primary practice address.
- Charles Boge, MD Orthopaedic Surgery NPI 1831299148
- Emily Cowles, R.D.,L.D. Dietitian, Registered NPI 1205125259
- Boyd Hammond, MEDICAL DOCTOR Surgery NPI 1871689844
- Shannon Jenkins, DO Pediatrics NPI 1023083680
- Michael Moore, M.D., P.C. Surgery NPI 1306064860
- Brian O'Byrne, MD Surgery NPI 1801896717
- Brandi Smith, APRN-CNP Nurse Practitioner NPI 1114447406
- Sarah Vlach, MD Physical Medicine & Rehabilitation NPI 1326002221
- William Wilson, M.D. Plastic Surgery NPI 1447368758
Specialties
-
Rehabilitation Practitioner PrimaryA health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 8079840 |
Practice context
Multi-provider organization. 9 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.