Healthcare Provider Details

I. General information

NPI: 1386869444
Provider Name (Legal Business Name): HURST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 OAKLEY AVE
BURLEY ID
83318-1840
US

IV. Provider business mailing address

1246 OAKLEY AVE
BURLEY ID
83318-1840
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-8184
  • Fax: 208-678-8164
Mailing address:
  • Phone: 208-678-8184
  • Fax: 208-678-8164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateID

VIII. Authorized Official

Name: DR. TYLER S. HURST
Title or Position: PRESIDENT
Credential: D.C.
Phone: 208-678-8184