Provider Demographics
NPI:1275794968
Name:SNAKE RIVER FAMILY CHIROPRACTIC HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:SNAKE RIVER FAMILY CHIROPRACTIC HEALTH AND WELLNESS CENTER
Other - Org Name:SNAKE RIVER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-528-4228
Mailing Address - Street 1:275 N WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4303
Mailing Address - Country:US
Mailing Address - Phone:208-528-4228
Mailing Address - Fax:208-523-4174
Practice Address - Street 1:275 N WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4303
Practice Address - Country:US
Practice Address - Phone:208-528-4228
Practice Address - Fax:208-523-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty