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General NPI Number Information
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NPI Number | 1093034936
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Entity Type | Organization
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Legal Business Name | MARSTON FAMILY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 5275 S DESELM WAY
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City | BOISE
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State | ID
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Zip | 83716-6904
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Country | US
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Telephone | 208-602-8616
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Fax |
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Provider Business Mailing Address
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Address Line | 5275 S DESELM WAY
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City | BOISE
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State | ID
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Zip | 83716-6904
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Country | US
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Telephone | 208-602-8616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA MARSTON
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Credential | D.C.
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Telephone | 208-602-8616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIA-1407
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License Number State | ID
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