=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760768428
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY ALIGNMENT CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2011
-----------------------------------------------------
Last Update Date | 01/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 742 E STATE ST STE 150
-----------------------------------------------------
City | EAGLE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83616-5941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-939-9432
-----------------------------------------------------
Fax | 208-244-3119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 742 E STATE ST STE 150
-----------------------------------------------------
City | EAGLE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83616-5941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-939-9432
-----------------------------------------------------
Fax | 208-244-3119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PATRICK NORMAN STROMER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 208-939-9432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | CHIA-1471
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------