Healthcare Provider Details

I. General information

NPI: 1649237603
Provider Name (Legal Business Name): KIRK ELLIOT PARGE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E ALBENI HWY SUITE 103
PRIEST RIVER ID
83856-9207
US

IV. Provider business mailing address

PO BOX 897
PRIEST RIVER ID
83856-0897
US

V. Phone/Fax

Practice location:
  • Phone: 208-448-4726
  • Fax: 208-448-4726
Mailing address:
  • Phone: 208-448-4726
  • Fax: 208-448-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCHIA835
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: