Provider Demographics
NPI:1952992927
Name:ADVANCED HEALTHCARE OF IDAHO
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE OF IDAHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-573-6999
Mailing Address - Street 1:2955 BROWNSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-7525
Mailing Address - Country:US
Mailing Address - Phone:208-573-6999
Mailing Address - Fax:
Practice Address - Street 1:2001 S WOODRUFF AVE STE 11
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6372
Practice Address - Country:US
Practice Address - Phone:208-573-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty