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General NPI Number Information
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NPI Number | 1821337205
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Entity Type | Organization
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Legal Business Name | CNC, INC.
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 3140 W MILANO DR SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-7290
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Country | US
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Telephone | 208-895-0022
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Fax | 208-898-9308
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Provider Business Mailing Address
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Address Line | 3140 W MILANO DR SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-7290
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Country | US
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Telephone | 208-895-0022
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Fax | 208-898-9308
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES G RIDDLE II
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Credential | PT, DPT
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Telephone | 208-895-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-1978
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License Number State | ID
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