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General NPI Number Information
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NPI Number | 1467535260
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Entity Type | Organization
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Legal Business Name | WIRICK FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2238 ST. CLAIR
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-523-1620
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Fax | 208-523-1497
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Provider Business Mailing Address
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Address Line | 1542 ELK CREEK DRIVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-523-1620
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Fax | 208-523-1497
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADY MATTHEW WIRICK
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Credential | DC
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Telephone | 208-523-1620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | CHIA1203
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License Number State | ID
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