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General NPI Number Information
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NPI Number | 1982806212
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Entity Type | Organization
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Legal Business Name | TOTAL WELLNESS CHIROPRACTIC AND HOLISTIC CARE LLC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 211 N WHITLEY DR SUITE 4
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City | FRUITLAND
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State | ID
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Zip | 83619-2704
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Country | US
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Telephone | 208-452-7582
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Fax |
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Provider Business Mailing Address
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Address Line | 211 N WHITLEY DR SUITE 4
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City | FRUITLAND
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State | ID
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Zip | 83619-2704
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Country | US
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Telephone | 208-452-7582
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN JAY LINDSEY
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Credential | DC
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Telephone | 208-452-7582
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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-1197
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License Number State | ID
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