Provider Demographics
NPI:1952862799
Name:EMPOWERED CHIROPRACTIC AND FITNESS LLC
Entity Type:Organization
Organization Name:EMPOWERED CHIROPRACTIC AND FITNESS LLC
Other - Org Name:EMPOWERED CHIROPRACTIC AND FITNESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WARWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-884-3368
Mailing Address - Street 1:1326 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1703
Mailing Address - Country:US
Mailing Address - Phone:208-884-3368
Mailing Address - Fax:208-884-3349
Practice Address - Street 1:1326 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1703
Practice Address - Country:US
Practice Address - Phone:208-884-3368
Practice Address - Fax:208-884-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCHIA-1873OtherCHIROPRACTIC PHYCICIANS LINCENSE