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General NPI Number Information
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NPI Number | 1770408171
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Entity Type | Organization
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Legal Business Name | NORDIC PINE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 8235 N CORNERSTONE DR
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City | HAYDEN
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State | ID
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Zip | 83835-8683
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Country | US
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Telephone | 208-762-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 8235 N CORNERSTONE DR
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City | HAYDEN
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State | ID
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Zip | 83835-8683
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Country | US
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Telephone | 208-762-0222
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DR. THOR BOSTROM
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Credential | DC
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Telephone | 425-417-8556
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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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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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