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General NPI Number Information
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NPI Number | 1629961453
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Entity Type | Organization
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Legal Business Name | ADAPT SPINE & SPORT
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 2145 N MAIN ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-5768
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Country | US
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Telephone | 208-298-9169
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 N MAIN ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-5768
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Country | US
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Telephone | 208-298-9169
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | AUSTIN STIVISON
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Credential | DC
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Telephone | 360-907-9841
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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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