NPI age
20 years
Enumerated 2005-10-18
Across 1165 active chiropractor providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1369362 | GROUP PTIN |
| 01 (ID) | C5610 | BLUE CROSS |
| 05 (ID) | 806406800 | |
| 01 (ID) | 1386675742 | GROUP NPI |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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