Healthcare Provider Details

I. General information

NPI: 1275794968
Provider Name (Legal Business Name): SNAKE RIVER FAMILY CHIROPRACTIC HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N WOODRUFF AVE
IDAHO FALLS ID
83401-4303
US

IV. Provider business mailing address

275 N WOODRUFF AVE
IDAHO FALLS ID
83401-4303
US

V. Phone/Fax

Practice location:
  • Phone: 208-528-4228
  • Fax: 208-523-4174
Mailing address:
  • Phone: 208-528-4228
  • Fax: 208-523-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1290
License Number StateID

VIII. Authorized Official

Name: DR. WADE KELLY PRICE
Title or Position: OFFICE MANAGER
Credential: D.C.
Phone: 208-528-4228