# EAGLE HEALTH AND WELLNESS, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083937049
- **Authorized official:** DR. KATHERINE MICHELLE ELSTUN MD (PRESIDENT AND MEDICAL DIRECTOR)
- **Authorized official phone:** (208) 938-4040

## Contact information

- **Practice address:** 3771 N EAGLE RD, BOISE, ID 83713-5005
- **Practice address phone:** (208) 938-4040
- **Practice address fax:** (208) 938-4099
- **Mailing address:** 3771 N EAGLE RD, BOISE, ID 83713-5005
- **Mailing address phone:** (208) 938-4040
- **Mailing address fax:** (208) 938-4099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | LCPC-2918 | ID | — |
| 111N00000X | Chiropractor | CHIA-1198 | ID | — |
| 207Q00000X | Family Medicine Physician | M-9150 | ID | Yes |

## Other

- **Enumeration date:** 03/04/2010
- **Last updated:** 03/04/2010