Provider Demographics
NPI:1184056814
Name:RIVER VALLEY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:RIVER VALLEY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-643-9023
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-0853
Mailing Address - Country:US
Mailing Address - Phone:208-643-9023
Mailing Address - Fax:208-643-9025
Practice Address - Street 1:34 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-5094
Practice Address - Country:US
Practice Address - Phone:208-643-9023
Practice Address - Fax:208-643-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1598101370OtherINDIVIDUAL NPI NUMBER