Healthcare Provider Details

I. General information

NPI: 1831591445
Provider Name (Legal Business Name): MAJA PAGE MCKNIGHT M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAJA PAGE CHAPMAN M.T

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 YELLOWSTONE AVE
POCATELLO ID
83201-4530
US

IV. Provider business mailing address

828 WASHINGTON AVE
POCATELLO ID
83201-3747
US

V. Phone/Fax

Practice location:
  • Phone: 208-680-6971
  • Fax:
Mailing address:
  • Phone: 208-680-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMASG-282
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: