Provider Demographics
NPI:1205004231
Name:KILOMET INC.
Entity Type:Organization
Organization Name:KILOMET INC.
Other - Org Name:ADVANCED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:ELLSWORTH
Authorized Official - Last Name:RANCK
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:208-921-0922
Mailing Address - Street 1:7207 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1852
Mailing Address - Country:US
Mailing Address - Phone:208-921-0922
Mailing Address - Fax:
Practice Address - Street 1:6720 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2032
Practice Address - Country:US
Practice Address - Phone:208-323-1440
Practice Address - Fax:208-323-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty