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General NPI Number Information
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NPI Number | 1467897405
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Entity Type | Organization
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Legal Business Name | DUDLEY CHIROPRACTIC P.A.
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 13965 W CHINDEN BLVD STE 210
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City | BOISE
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State | ID
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Zip | 83713-1457
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Country | US
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Telephone | 208-344-3610
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Fax | 208-417-1888
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Provider Business Mailing Address
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Address Line | 13965 W CHINDEN BLVD STE 210
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City | BOISE
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State | ID
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Zip | 83713-1457
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Country | US
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Telephone | 208-266-7000
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Fax | 208-417-1888
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN BALLARD WEED
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Credential | DC
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Telephone | 208-266-7000
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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-868
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License Number State | ID
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Taxonomy #2
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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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