Healthcare Provider Details

I. General information

NPI: 1215437751
Provider Name (Legal Business Name): ELEVATED LIFE FAMILY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N EMERSON AVE
SHELLEY ID
83274-1105
US

IV. Provider business mailing address

120 N EMERSON AVE
SHELLEY ID
83274-1105
US

V. Phone/Fax

Practice location:
  • Phone: 208-357-1949
  • Fax:
Mailing address:
  • Phone: 208-357-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL SEARLE
Title or Position: OWNER
Credential: DC
Phone: 208-357-1949