Idaho Spine Clinic LLC
Organization Active NPI Chiropractor · Malad City, ID
NPI 1679805535 · NPPES record last updated Feb 3, 2010
Key facts
- NPI
- 1679805535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIA-837 (ID)
- Legal business name
- IDAHO SPINE CLINIC LLC
- Practice address
- 148 E 50 S
Malad City, ID 83252-1368 - Phone
- (208) 766-8111
- Fax
- (208) 766-8111
- NPI assigned
- Feb 3, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Ronald Eugene Perry, DC
- Title
- Doctor of Chiropractic
- Phone
- (208) 766-8111
Practitioners 1
-
Bradley Jay Devereaux, D.C.
National Provider Directory
Locations
148 E 50 S
Malad City, ID 83252
Phone (208) 766-8111
190 W 100 S
#A
Bountiful, UT 84010
Phone (801) 292-1111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHIA-837 | ID | Yes |
Addresses
Primary practice location
148 E 50 S
Malad City, ID 83252-1368
Mailing address
PO Box 69
Malad City, ID 83252-0069
Phone (208) 766-8111
Other providers in Malad City, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.