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General NPI Number Information
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NPI Number | 1205618840
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Entity Type | Organization
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Legal Business Name | HEALTH SPARK, LLC
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 4771 N SUMMIT WAY STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-5017
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Country | US
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Telephone | 208-994-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 4771 N SUMMIT WAY STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-5017
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Country | US
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Telephone | 208-994-4747
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL ALLEN
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Credential | DC
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Telephone | 208-994-4747
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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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