Provider Demographics
NPI: | 1265677785 |
---|---|
Name: | CHIROPRACTIC PLUS |
Entity Type: | Organization |
Organization Name: | CHIROPRACTIC PLUS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHRISTOPHER |
Authorized Official - Middle Name: | ALLAN |
Authorized Official - Last Name: | THOMAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 509-447-2414 |
Mailing Address - Street 1: | PO BOX 2402 |
Mailing Address - Street 2: | |
Mailing Address - City: | PRIEST RIVER |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83856-2402 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-448-4726 |
Mailing Address - Fax: | 208-448-4726 |
Practice Address - Street 1: | 314 E ALBENI HWY, SUITE 103 |
Practice Address - Street 2: | |
Practice Address - City: | PRIEST RIVER |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83856-2402 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-448-4726 |
Practice Address - Fax: | 208-448-4726 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-12-12 |
Last Update Date: | 2008-12-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ID | CHIA-1339 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |