Provider Demographics
NPI:1326345976
Name:HUMAN DYNAMICS AND DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:HUMAN DYNAMICS AND DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-522-0140
Mailing Address - Street 1:2267 TETON PLZ
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6486
Mailing Address - Country:US
Mailing Address - Phone:208-524-4953
Mailing Address - Fax:208-524-4953
Practice Address - Street 1:111 LILLIAN ST STE 204
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4301
Practice Address - Country:US
Practice Address - Phone:208-756-2344
Practice Address - Fax:208-756-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities