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General NPI Number Information
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NPI Number | 1245519693
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Entity Type | Organization
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Legal Business Name | J. B. EGBERT CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 1134 BOND AVE
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City | REXBURG
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State | ID
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Zip | 83440-3582
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Country | US
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Telephone | 208-356-8818
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Fax | 208-356-0458
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Provider Business Mailing Address
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Address Line | 1134 BOND AVE
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City | REXBURG
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State | ID
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Zip | 83440-3582
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN B. EGBERT
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Credential |
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Telephone | 208-356-8818
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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 1449
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License Number State | ID
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