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General NPI Number Information
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NPI Number | 1427169614
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Entity Type | Organization
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Legal Business Name | IRONWOOD CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1410 LINCOLN WAY STE 200
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2300
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Country | US
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Telephone | 208-667-0823
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 LINCOLN WAY STE 200
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2300
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Country | US
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Telephone | 208-667-0823
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Fax |
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Authorized Official
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Title or Position | OWNER/SECRETARY
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Name | DR. ANDREW THOMAS EVENSON
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Credential | D.C.
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Telephone | 208-667-0823
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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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