Healthcare Provider Details

I. General information

NPI: 1265542435
Provider Name (Legal Business Name): RESET P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N 4TH ST
MONTPELIER ID
83254-1050
US

IV. Provider business mailing address

PO BOX 26
MONTPELIER ID
83254-0026
US

V. Phone/Fax

Practice location:
  • Phone: 208-847-2273
  • Fax: 208-847-0678
Mailing address:
  • Phone: 208-847-2273
  • Fax: 208-847-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1106
License Number StateID

VIII. Authorized Official

Name: MATTHEW BRINTON STEVENS
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 208-847-2273