Healthcare Provider Details

I. General information

NPI: 1225068059
Provider Name (Legal Business Name): SALMON RIVER CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S DAISY ST SUITE A
SALMON ID
83467-4333
US

IV. Provider business mailing address

104 S DAISY ST SUITE A
SALMON ID
83467-4333
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-5000
  • Fax:
Mailing address:
  • Phone: 208-756-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1182
License Number StateID

VIII. Authorized Official

Name: DR. JENNIFER VICTORIA COFFEY
Title or Position: CO - PRESIDENT
Credential: D.C.
Phone: 208-879-6754