Provider Demographics
NPI:1912418716
Name:CORE WELLNESS PLLC
Entity Type:Organization
Organization Name:CORE WELLNESS PLLC
Other - Org Name:CORE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-991-6064
Mailing Address - Street 1:3307 CALDWELL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-6403
Mailing Address - Country:US
Mailing Address - Phone:208-991-6064
Mailing Address - Fax:
Practice Address - Street 1:3307 CALDWELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-6403
Practice Address - Country:US
Practice Address - Phone:208-991-6064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty