Provider Demographics
NPI:1417711284
Name:BLACKFOOT HEALTH & WELLNESS CENTER, LLC.
Entity Type:Organization
Organization Name:BLACKFOOT HEALTH & WELLNESS CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-356-6772
Mailing Address - Street 1:105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1826
Mailing Address - Country:US
Mailing Address - Phone:208-356-6772
Mailing Address - Fax:
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1826
Practice Address - Country:US
Practice Address - Phone:208-356-6772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty