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General NPI Number Information
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NPI Number | 1487829107
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Entity Type | Organization
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Legal Business Name | DANIEL M PEWE DC PC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 288 HIGHWAY 16 STE 101
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City | EMMETT
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State | ID
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Zip | 83617-5082
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Country | US
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Telephone | 208-365-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 288 HIGHWAY 16 STE 101
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City | EMMETT
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State | ID
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Zip | 83617-5082
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Country | US
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Telephone | 208-365-2225
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL MICHAEL PEWE
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Credential | DC
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Telephone | 208-365-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CHIA-724
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License Number State | ID
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