Healthcare Provider Details

I. General information

NPI: 1659801140
Provider Name (Legal Business Name): LEAN ON ME CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5624 N GOVERNMENT WAY STE 6
DALTON GARDENS ID
83815-7350
US

IV. Provider business mailing address

2138 W ROUSSEAU DR
COEUR D ALENE ID
83815-9152
US

V. Phone/Fax

Practice location:
  • Phone: 208-758-0200
  • Fax: 816-605-5050
Mailing address:
  • Phone: 816-605-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCHIA-1768
License Number StateID

VIII. Authorized Official

Name: DUSTIN S. MEYER
Title or Position: OWNER/OPERATOR
Credential: DC
Phone: 816-605-5050