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General NPI Number Information
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NPI Number | 1104055383
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Entity Type | Individual
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Provider Name | MARIA TERESA GOMEZ SIRUCEK D.C.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 3080 E GENTRY WAY SUITE 110
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City | MERIDIAN
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State | ID
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Zip | 83642-3544
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Country | US
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Telephone | 208-345-7262
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Fax | 208-343-1953
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Provider Business Mailing Address
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Address Line | 3080 E GENTRY WAY SUITE 110
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City | MERIDIAN
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State | ID
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Zip | 83642-3544
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Country | US
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Telephone | 208-345-7262
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Fax | 208-343-1953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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-1370
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | CHIA-1370
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License Number State | ID
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