Provider Demographics
NPI:1700031515
Name:NEVILLE, TREVER L (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVER
Middle Name:L
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-2904
Mailing Address - Country:US
Mailing Address - Phone:208-522-3130
Mailing Address - Fax:
Practice Address - Street 1:2143 WEST BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:IDAHO FALSS
Practice Address - State:ID
Practice Address - Zip Code:83402
Practice Address - Country:US
Practice Address - Phone:208-522-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor