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General NPI Number Information
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NPI Number | 1962157438
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Entity Type | Organization
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Legal Business Name | NEUROFEEDBACK CENTER
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 2001 S WOODRUFF AVE STE 11
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6372
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Country | US
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Telephone | 208-206-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 S WOODRUFF AVE STE 11
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6372
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Country | US
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Telephone | 208-206-0599
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TONI PATTERSON
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Credential |
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Telephone | 208-206-0599
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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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