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General NPI Number Information
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NPI Number | 1942923719
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Entity Type | Individual
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Provider Name | MATTHEW PRIEBE DC
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Gender | Male
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 8109 N WAYNE BLVD
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City | HAYDEN
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State | ID
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Zip | 83835-5031
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Country | US
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Telephone | 208-667-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 5815 N MOUNT CARROL ST
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City | DALTON GARDENS
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State | ID
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Zip | 83815-9620
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Country | US
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Telephone | 208-277-7541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CHIA-2302
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License Number State | ID
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