Provider Demographics
NPI:1841584760
Name:IDAHO NATUROPATHIC MEDICINE, LLC
Entity Type:Organization
Organization Name:IDAHO NATUROPATHIC MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:208-275-0007
Mailing Address - Street 1:6550 W EMERALD ST
Mailing Address - Street 2:STE 112
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8780
Mailing Address - Country:US
Mailing Address - Phone:208-275-0007
Mailing Address - Fax:208-323-9909
Practice Address - Street 1:6550 W EMERALD ST
Practice Address - Street 2:STE 112
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8780
Practice Address - Country:US
Practice Address - Phone:208-275-0007
Practice Address - Fax:208-323-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNAT-54175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty