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General NPI Number Information
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NPI Number | 1871856047
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Entity Type | Organization
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Legal Business Name | BOISE PAIN MANAGEMENT
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 8950 W EMERALD ST STE 150
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City | BOISE
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State | ID
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Zip | 83704-8296
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Country | US
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Telephone | 208-376-4571
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Fax | 208-376-4621
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Provider Business Mailing Address
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Address Line | 8950 W EMERALD ST STE 150
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City | BOISE
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State | ID
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Zip | 83704-8296
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Country | US
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Telephone | 208-376-4571
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Fax | 208-376-4621
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Authorized Official
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Title or Position | NCTMB
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Name | MR. MICHAEL JOSEPH PLYER
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Credential |
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Telephone | 208-376-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 155194-00
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License Number State | CA
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