# WIRICK FAMILY CHIROPRACTIC

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

## Provider details

- **NPI number:** 1467535260
- **Authorized official:** DR. BRADY MATTHEW WIRICK DC (PRESIDENT)
- **Authorized official phone:** (208) 523-1620

## Contact information

- **Practice address:** 2238 ST. CLAIR, IDAHO FALLS, ID 83404
- **Practice address phone:** (208) 523-1620
- **Practice address fax:** (208) 523-1497
- **Mailing address:** 1542 ELK CREEK DRIVE, IDAHO FALLS, ID 83404
- **Mailing address phone:** (208) 523-1620
- **Mailing address fax:** (208) 523-1497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NN0400X | Neurology Chiropractor | CHIA1203 | ID | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1164524658 | PROVIDER NPI | ID |