Provider Demographics
NPI:1518225150
Name:ST MARIES CHIROPRACTIC INC
Entity type:Organization
Organization Name:ST MARIES CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-245-3420
Mailing Address - Street 1:533 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-2060
Mailing Address - Country:US
Mailing Address - Phone:208-245-3420
Mailing Address - Fax:208-245-3420
Practice Address - Street 1:533 MAIN AVE
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-2060
Practice Address - Country:US
Practice Address - Phone:208-245-3420
Practice Address - Fax:208-245-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 527261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care