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General NPI Number Information
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NPI Number | 1952196438
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Entity Type | Organization
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Legal Business Name | MICHAEL WELLNESS VENTURES PLLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1299 E IRON EAGLE DR STE 130
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City | EAGLE
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State | ID
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Zip | 83616-6869
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Country | US
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Telephone | 208-582-3421
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Fax |
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Provider Business Mailing Address
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Address Line | 7071 W BELHAVEN DR
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City | BOISE
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State | ID
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Zip | 83714-2477
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DILLON JADE MICHAEL
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Credential | DC
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Telephone | 208-582-3421
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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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