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General NPI Number Information
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NPI Number | 1669141503
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Entity Type | Organization
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Legal Business Name | MADISON RIDGE CHIROPRACTIC
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 1096 ERIKSON DR
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City | REXBURG
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State | ID
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Zip | 83440-5297
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Country | US
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Telephone | 208-656-3205
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Fax | 208-656-3206
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Provider Business Mailing Address
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Address Line | 1096 ERIKSON DR
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City | REXBURG
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State | ID
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Zip | 83440-5297
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Country | US
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Telephone | 208-656-3205
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Fax | 208-656-3206
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | EMILY ARMSTRONG
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Credential |
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Telephone | 208-656-3205
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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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