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General NPI Number Information
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NPI Number | 1265745244
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Entity Type | Organization
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Legal Business Name | BRAD JAMISON CHIROPRACTIC, P.L.L.C.
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 671 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5596
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Country | US
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Telephone | 208-552-2584
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Fax | 208-529-3992
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Provider Business Mailing Address
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Address Line | 671 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5596
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Country | US
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Telephone | 208-552-2584
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Fax | 208-529-3992
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Authorized Official
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Title or Position | DOCTOR / OWNER
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Name | NOLAN BRADLEY JAMISON
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Credential | D.C.
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Telephone | 208-552-2584
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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 | CHIA467
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License Number State | ID
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