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General NPI Number Information
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NPI Number | 1750670824
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Entity Type | Organization
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Legal Business Name | ELEVATION CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 10451 W GARVERDALE CT STE 204
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City | BOISE
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State | ID
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Zip | 83704-5475
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Country | US
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Telephone | 208-287-9393
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Fax | 208-287-9394
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Provider Business Mailing Address
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Address Line | 10451 W GARVERDALE CT STE 204
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City | BOISE
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State | ID
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Zip | 83704-5475
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Country | US
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Telephone | 208-287-9393
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Fax | 208-287-9394
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC/ OWNER
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Name | DR. BRANDON L COUCHMAN
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Credential | D.C.
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Telephone | 208-287-9393
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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-1451
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License Number State | ID
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