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General NPI Number Information
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NPI Number | 1083846489
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Entity Type | Organization
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Legal Business Name | JERICHO HEALTH & WELLNESS, PC
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 1250 W IRONWOOD DR SUITE 301
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2679
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Country | US
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Telephone | 208-664-5455
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Fax | 208-664-5422
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Provider Business Mailing Address
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Address Line | 1250 W IRONWOOD DR SUITE 301
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2679
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Country | US
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Telephone | 208-664-5455
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Fax | 208-664-5422
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Authorized Official
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Title or Position | VICE PRESIDENT/OFFICE MANAGER
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Name | KELSEY J SRSTKA
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Credential |
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Telephone | 208-664-5455
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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 | CHIA-1369
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License Number State | ID
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