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General NPI Number Information
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NPI Number | 1578898151
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Entity Type | Organization
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Legal Business Name | GOTT CHIROPRACTIC INC.
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 3183 N. COLE RD.
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-794-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 13871 W. DOMINION CT.
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City | BOISE
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State | ID
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Zip | 83713-0718
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Country | US
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Telephone | 208-794-4774
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Fax | 208-466-9240
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Authorized Official
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Title or Position | CEO
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Name | DR. GEORGE MICHAEL GOTT
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Credential | D.C.
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Telephone | 208-794-4774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CHIA 490
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License Number State | ID
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