MEDICARE: SPINAL REHAB OF NORTH COUNTY

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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1417498056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL REHAB OF NORTH COUNTY

Provider Business Mailing Address
First Line	:	2168 W GROVE PKWY STE 200
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-6748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 VILLAGE PARK AVE STE 100
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:	208-944-6620
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATE D MILLER
Credential	:	DC
Telephone Number	:	801-899-2053

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	11/20/2025

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