NPI 1154593705

Eastern Idaho Spine Center

Organisation Rehabilitation Practitioner Idaho Falls, ID

Practice location

Address: 2860 Channing Way STE 112, Idaho Falls, ID 83404-7531
Phone: (208) 535-4343
Fax: (208) 535-4344

Authorised official

Name: Shane Christian Mangrum
Title: Owner
Phone: (208) 535-4343

Registered specialties

Rehabilitation Practitioner Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225400000X

Other Rehabilitation Practitioner providers in Idaho →

Registry record

NPI: 1154593705
Entity type: Organization
NPI issued: 24 Mar 2008
Record last updated: 6 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.