Provider Demographics
NPI:1386682292
Name:TREASURE VALLEY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TREASURE VALLEY CHIROPRACTIC PLLC
Other - Org Name:THE TREASURE VALLEY CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-938-8828
Mailing Address - Street 1:49 N PALMETTO AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5149
Mailing Address - Country:US
Mailing Address - Phone:208-938-8828
Mailing Address - Fax:866-817-3318
Practice Address - Street 1:49 N PALMETTO AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5149
Practice Address - Country:US
Practice Address - Phone:208-938-8828
Practice Address - Fax:866-817-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty