Healthcare Provider Details

I. General information

NPI: 1407553621
Provider Name (Legal Business Name): KIRSCH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 E. STATE ST. STE 150
EAGLE ID
83616
US

IV. Provider business mailing address

P.O. BOX 384
MIDDLETON ID
83644
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-3750
  • Fax: 208-939-3754
Mailing address:
  • Phone: 208-406-7780
  • Fax: 208-939-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA M KIRSCH
Title or Position: OWNER AND PROVIDER
Credential: D.O.
Phone: 208-406-7780