NPI 1720521719

Advanced Chiropractic of Blackfoot

Organisation Preferred Provider Organization Blackfoot, ID

Practice location

Address: 1395 NW Main St, Blackfoot, ID 83221-3936
Phone: (208) 785-0270
Fax: (208) 785-0683
Mailing address: 725 Jensen Grove Dr Suite #4, Blackfoot, ID 83221-1636

Authorised official

Name: Dee Scott Stevens
Title: Owner Operator
Phone: (208) 785-0270

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence CHIA-1502 (ID)

Other Preferred Provider Organization providers in Idaho →

Registry record

NPI: 1720521719
Entity type: Organization
NPI issued: 23 Nov 2016
Record last updated: 4 Nov 2019

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.