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General NPI Number Information
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NPI Number | 1891350658
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Entity Type | Organization
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Legal Business Name | SALTY ICE LLP
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 910 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1308
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Country | US
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Telephone | 208-917-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 910 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1308
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Country | US
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Telephone | 208-917-9799
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JOEL SALTER
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Credential | NP
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Telephone | 435-229-2285
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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