Healthcare Provider Details

I. General information

NPI: 1114280203
Provider Name (Legal Business Name): COLBY TODD INZER N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AIKENS RD SUITE B
EAGLE ID
83616-4900
US

IV. Provider business mailing address

PO BOX 1365
EAGLE ID
83616-1365
US

V. Phone/Fax

Practice location:
  • Phone: 208-995-2891
  • Fax: 208-995-3891
Mailing address:
  • Phone: 208-995-2891
  • Fax: 208-995-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: