Provider Demographics
NPI:1336273267
Name:HEALTHY HABITS WELLNESS CLINIC INC
Entity Type:Organization
Organization Name:HEALTHY HABITS WELLNESS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:LUNDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-887-4872
Mailing Address - Street 1:14 S BALTIC PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5935
Mailing Address - Country:US
Mailing Address - Phone:208-887-4872
Mailing Address - Fax:208-887-6331
Practice Address - Street 1:14 S BALTIC PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5935
Practice Address - Country:US
Practice Address - Phone:208-887-4872
Practice Address - Fax:208-887-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1089111N00000X
363LF0000X, 363LF0000X
IDNP-701A363L00000X
IDNP-139A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty