Individual
CHAD ARWYN DAVIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
717 W ELDREDGE RD, POCATELLO, ID 83201-5620
(208) 480-1250
Mailing address
717 W ELDREDGE RD, POCATELLO, ID 83201-5620
(208) 480-1250
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922463751
—
CA
Enumeration date
11/02/2017
Last updated
11/02/2017
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