Healthcare Provider Details

I. General information

NPI: 1508025875
Provider Name (Legal Business Name): INTERMOUNTAIN CONSERVATIVE HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 MAIN ST
PLYMOUTH NH
03264-1527
US

IV. Provider business mailing address

178 MAIN ST
PLYMOUTH NH
03264-1527
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-5566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6731102
License Number StateNH

VIII. Authorized Official

Name: JAMES PAMPLIN
Title or Position: PRESIDENT
Credential: DC
Phone: 603-536-5566