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General NPI Number Information
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NPI Number | 1316286081
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Entity Type | Organization
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Legal Business Name | FIT 4 LIFE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 2086 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6490
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Country | US
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Telephone | 208-360-7711
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Fax | 208-549-7106
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Provider Business Mailing Address
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Address Line | 2086 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6490
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Country | US
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Telephone | 208-360-7711
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Fax | 208-549-7106
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ABBEY L PATTERSON
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Credential |
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Telephone | 208-360-7711
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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 | ID
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