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NPI Code Detail

MEDICARE: SUMMIT FAMILY CHIROPRACTIC

MEDICARE: SUMMIT FAMILY CHIROPRACTIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCHIA1447ID

General Provider Information

NPI Number : 1295012623
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMIT FAMILY CHIROPRACTIC
Provider Business Mailing Address
First Line : 2634 N GOVERNMENT WAY
Second Line :
City : COEUR D ALENE
State : ID
Zip : 83815-3750
Country : US
Telephone Number : 208-771-4474
Fax Number : 208-664-1001
Provider Business Practice Location Address
First Line : 2634 N GOVERNMENT WAY
Second Line :
City : COEUR D ALENE
State : ID
Zip : 83815-3750
Country : US
Telephone Number : 208-771-4474
Fax Number : 208-664-1001
Authorized Official
Title or Position : CHIROPRACTIC
Name : RYAN SOUSLEY
Credential : DC
Telephone Number : 208-771-4474
Provider Enumeration Date : 11/14/2011
Last Update Date : 12/19/2016

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Directions to “SUMMIT FAMILY CHIROPRACTIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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