Provider Demographics
NPI:1083899124
Name:BITTERROOT REGIONAL CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BITTERROOT REGIONAL CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-756-1428
Mailing Address - Street 1:818 MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4350
Mailing Address - Country:US
Mailing Address - Phone:208-756-1428
Mailing Address - Fax:
Practice Address - Street 1:818 MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4350
Practice Address - Country:US
Practice Address - Phone:208-756-1428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 1282261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center