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General NPI Number Information
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NPI Number | 1184056814
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 34 SE MAIN ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-5094
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Country | US
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Telephone | 208-643-9023
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Fax | 208-643-9025
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Provider Business Mailing Address
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Address Line | PO BOX 853
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City | BLACKFOOT
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State | ID
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Zip | 83221-0853
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Country | US
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Telephone | 208-643-9023
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Fax | 208-643-9025
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC/OWNER
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Name | DR. SCOTT DELANE SMITH
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Credential | D.C.
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Telephone | 208-643-9023
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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 |
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License Number State |
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