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General NPI Number Information
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NPI Number | 1124351770
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Entity Type | Organization
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Legal Business Name | GUNNELL FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 1203 10TH ST S
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City | NAMPA
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State | ID
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Zip | 83651-4611
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Country | US
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Telephone | 208-249-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 3116 S AVONDALE AVE
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City | NAMPA
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State | ID
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Zip | 83686-3002
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Country | US
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Telephone | 208-249-5333
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Fax |
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | DR. JEFFREY T GUNNELL
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Credential | D.C.
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Telephone | 208-249-5333
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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-1149
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License Number State | ID
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