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General NPI Number Information
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NPI Number | 1942407333
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Entity Type | Organization
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Legal Business Name | CELEBRATE LIFE WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 7750 W CRESTWOOD DRIVE #1
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-376-5433
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Fax | 208-376-5636
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Provider Business Mailing Address
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Address Line | 7750 W CRESTWOOD DRIVE #1
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-376-5433
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Fax | 208-376-5636
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA A BRESHEARS
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Credential |
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Telephone | 208-866-1490
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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 | CHIA428
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License Number State | ID
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