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General NPI Number Information
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NPI Number | 1275794968
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Entity Type | Organization
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Legal Business Name | SNAKE RIVER FAMILY CHIROPRACTIC HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 275 N WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4303
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Country | US
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Telephone | 208-528-4228
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Fax | 208-523-4174
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Provider Business Mailing Address
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Address Line | 275 N WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4303
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Country | US
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Telephone | 208-528-4228
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Fax | 208-523-4174
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. WADE KELLY PRICE
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Credential | D.C.
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Telephone | 208-528-4228
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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-1290
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License Number State | ID
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