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General NPI Number Information
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NPI Number | 1801118427
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Entity Type | Organization
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Legal Business Name | STAKER CHIROPRACTIC PC
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 976 JOHN ADAMS PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4049
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Country | US
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Telephone | 208-522-5546
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Fax | 208-522-4777
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Provider Business Mailing Address
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Address Line | 976 JOHN ADAMS PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4049
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Country | US
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Telephone | 208-522-5546
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Fax | 208-522-4777
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD D STAKER
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Credential | D.C.
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Telephone | 208-522-5546
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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 | CHIA706
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License Number State | ID
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