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General NPI Number Information
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NPI Number | 1326414673
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Entity Type | Organization
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Legal Business Name | DOUGLAS R. SCHULTZ
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 2285 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4724
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Country | US
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Telephone | 480-340-3807
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Fax |
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Provider Business Mailing Address
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Address Line | 2285 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4724
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Country | US
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Telephone | 480-340-3807
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. DOUGLAS RYAN SCHULTZ
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Credential | D.C.
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Telephone | 480-340-3807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | CHIA-1634
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License Number State | ID
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