# MIND AND BODY RESTORED

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

## Provider details

- **NPI number:** 1295420651
- **Authorized official:** JANA QUALL NP (NP)
- **Authorized official phone:** (208) 957-7808

## Contact information

- **Practice address:** 913 W CANFIELD AVE, COEUR D ALENE, ID 83815-9764
- **Practice address phone:** (208) 957-7808
- **Practice address fax:** (949) 695-2456
- **Mailing address:** 3117 W AUGUSTIN DR, COEUR D ALENE, ID 83815-5362
- **Mailing address phone:** (208) 957-7808
- **Mailing address fax:** (949) 695-2456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/10/2023
- **Last updated:** 12/05/2023