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General NPI Number Information
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NPI Number | 1104234236
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Entity Type | Organization
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Legal Business Name | THRIVE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 1230 N NORTHWOOD CENTER CT
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4941
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Country | US
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Telephone | 208-665-9688
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 546
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City | CARDIFF
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State | CA
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Zip | 92007-0546
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Country | US
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Telephone | 760-436-7671
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Fax | 760-797-1845
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Authorized Official
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Title or Position | OFFICER/OWNER/CHIROPRACTOR
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Name | JEFFREY PEARSON
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Credential | DC
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Telephone | 208-665-9688
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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-1594
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-1595
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License Number State | ID
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