Provider Demographics
NPI:1578973699
Name:EWC WEISER PLLC
Entity Type:Organization
Organization Name:EWC WEISER PLLC
Other - Org Name:ELEMENTAL WELLNESS AND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-414-3333
Mailing Address - Street 1:343 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-2515
Mailing Address - Country:US
Mailing Address - Phone:208-414-3333
Mailing Address - Fax:208-414-3332
Practice Address - Street 1:343 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-2515
Practice Address - Country:US
Practice Address - Phone:208-414-3333
Practice Address - Fax:208-414-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty