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General NPI Number Information
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NPI Number | 1316275969
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Entity Type | Organization
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Legal Business Name | IDAHO SCOLIOSIS SPECIALISTS PLLC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 10751 W OVERLAND RD SUITE A 62
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City | BOISE
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State | ID
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Zip | 83709-1375
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Country | US
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Telephone | 208-888-0055
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Fax | 208-888-5062
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Provider Business Mailing Address
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Address Line | 10751 W OVERLAND RD SUITE A 62
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City | BOISE
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State | ID
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Zip | 83709-1375
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Country | US
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Telephone | 208-888-0055
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Fax | 208-888-5062
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. SUSAN L CUNNINGHAM
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Credential | D.C.
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Telephone | 208-888-0055
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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 |
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License Number State |
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