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General NPI Number Information
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NPI Number | 1023793361
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Entity Type | Organization
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Legal Business Name | PREMIER SPORTS & SPINE
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 1320 S AMMON RD
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City | AMMON
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State | ID
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Zip | 83406-5810
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Country | US
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Telephone | 208-360-6770
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Fax | 208-542-6353
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Provider Business Mailing Address
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Address Line | 1786 47TH ST
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City | AMMON
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State | ID
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Zip | 83401-6565
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Country | US
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Telephone | 208-360-6770
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Fax | 208-542-6353
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Authorized Official
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Title or Position | OWNER
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Name | DR. ZACHARY STEVEN LOVELL
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Credential | DC
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Telephone | 208-360-6770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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