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General NPI Number Information
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NPI Number | 1265542435
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Entity Type | Organization
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Legal Business Name | RESET P.A.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 710 N 4TH ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1050
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Country | US
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Telephone | 208-847-2273
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Fax | 208-847-0678
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Provider Business Mailing Address
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Address Line | PO BOX 26
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City | MONTPELIER
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State | ID
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Zip | 83254-0026
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Country | US
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Telephone | 208-847-2273
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Fax | 208-847-0678
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MATTHEW BRINTON STEVENS
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Credential | D.C.
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Telephone | 208-847-2273
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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 | 1106
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License Number State | ID
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