Healthcare Provider Details

I. General information

NPI: 1215091863
Provider Name (Legal Business Name): MICHAEL DAVID HARDISON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 E SELTICE WAY
POST FALLS ID
83854-7022
US

IV. Provider business mailing address

1624 E SELTICE WAY
POST FALLS ID
83854-7022
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-0128
  • Fax: 208-773-9600
Mailing address:
  • Phone: 208-777-0128
  • Fax: 208-773-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1071256
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA964
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: