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General NPI Number Information
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NPI Number | 1407215668
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Entity Type | Organization
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Legal Business Name | ENSO CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 903 N MAIN ST
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City | MERIDIAN
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State | ID
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Zip | 83642-2301
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Country | US
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Telephone | 208-887-4747
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Fax | 208-887-4657
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Provider Business Mailing Address
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Address Line | 3313 W CHERRY LN PMB 703
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City | MERIDIAN
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State | ID
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Zip | 83642-1119
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Country | US
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Telephone | 208-887-4747
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Fax | 208-887-4657
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Authorized Official
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Title or Position | MEMBER / CHIROPRACTOR
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Name | DR. WADE DARREL SUMMERS
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Credential | D.C.
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Telephone | 208-887-4747
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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-1703
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License Number State | ID
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