Provider Demographics
NPI:1427596238
Name:THE HEALTH RANCH, INC.
Entity Type:Organization
Organization Name:THE HEALTH RANCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-961-0297
Mailing Address - Street 1:1100 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-1856
Mailing Address - Country:US
Mailing Address - Phone:208-324-6656
Mailing Address - Fax:208-324-1492
Practice Address - Street 1:1100 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-1856
Practice Address - Country:US
Practice Address - Phone:208-324-6656
Practice Address - Fax:208-324-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty