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General NPI Number Information
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NPI Number | 1306435490
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Entity Type | Organization
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Legal Business Name | HEALING TOUCH OSTEOPATHIC PC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 10199 W CARLTON BAY DR
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City | GARDEN CITY
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State | ID
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Zip | 83714-5150
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Country | US
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Telephone | 208-488-8408
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Fax |
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Provider Business Mailing Address
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Address Line | 8123 CASA REAL LN
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City | BOISE
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State | ID
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Zip | 83714-2543
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Country | US
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Telephone | 208-488-8408
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON MICAH BREVIG
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Credential | DO
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Telephone | 208-994-4962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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